Provider Demographics
NPI:1710985387
Name:GAFFNEY, JOHN L (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:GAFFNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2218
Mailing Address - Country:US
Mailing Address - Phone:609-823-6161
Mailing Address - Fax:609-823-3413
Practice Address - Street 1:9501 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:NJ
Practice Address - Zip Code:08402-2218
Practice Address - Country:US
Practice Address - Phone:609-823-6161
Practice Address - Fax:609-823-3413
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB53760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0505756000OtherAMERIHEALTH
NJ0K6560OtherHEALTHNET
NJATP031OtherOXFORD
NJ3098OtherAETNA
NJJ1794OtherHORIZON
NJ13532OtherAETNA
NJ4602102Medicaid
NJ4199053OtherAETNA
NJ672509CY9Medicare ID - Type Unspecified
NJ672509SBVMedicare PIN
NJE86592Medicare UPIN