Provider Demographics
NPI:1760453872
Name:NAZIM A JAFFER
Entity Type:Organization
Organization Name:NAZIM A JAFFER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-898-1723
Mailing Address - Street 1:4308 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1052
Mailing Address - Country:US
Mailing Address - Phone:330-759-7038
Mailing Address - Fax:330-759-7071
Practice Address - Street 1:4308 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1052
Practice Address - Country:US
Practice Address - Phone:330-759-7038
Practice Address - Fax:330-759-7071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAZIM A JAFFER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-27
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH035182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA74490Medicare UPIN
0391363Medicare PIN