Provider Demographics
NPI:1891725248
Name:JAFFE, MORTON A (MD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:A
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3064
Mailing Address - Country:US
Mailing Address - Phone:973-875-2012
Mailing Address - Fax:973-250-4166
Practice Address - Street 1:525 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8141
Practice Address - Country:US
Practice Address - Phone:212-888-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0862552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B88639Medicare UPIN
919551Medicare ID - Type Unspecified