Provider Demographics
NPI:1376699199
Name:JAFFAR, REEMA (MD)
Entity type:Individual
Prefix:
First Name:REEMA
Middle Name:
Last Name:JAFFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REEMA
Other - Middle Name:
Other - Last Name:VASENWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 COLUMBUS CIR STE A
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3907
Mailing Address - Country:US
Mailing Address - Phone:866-909-7284
Mailing Address - Fax:908-272-1478
Practice Address - Street 1:300 COLUMBUS CIR STE A
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3907
Practice Address - Country:US
Practice Address - Phone:866-909-7284
Practice Address - Fax:908-272-1478
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10156100207ZP0102X
IN01071489A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0583855Medicaid
IN000000774700OtherANTHEM
IN352037910020OtherTRICARE
IN201078570Medicaid