Provider Demographics
NPI:1821307257
Name:JAFFE, RENA (FNP)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 RINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1343
Mailing Address - Country:US
Mailing Address - Phone:973-831-6700
Mailing Address - Fax:973-831-6703
Practice Address - Street 1:1485 UNION VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1391
Practice Address - Country:US
Practice Address - Phone:973-728-1880
Practice Address - Fax:973-728-1559
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY366487363LF0000X
NJ26NJ00321600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily