Provider Demographics
NPI:1700854270
Name:SCHAFFER, JEFFREY P
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2605
Mailing Address - Country:US
Mailing Address - Phone:516-432-6666
Mailing Address - Fax:516-432-7509
Practice Address - Street 1:760 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2605
Practice Address - Country:US
Practice Address - Phone:516-432-6666
Practice Address - Fax:516-432-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00237494Medicaid
NYC08168Medicare UPIN
NY00237494Medicaid