Provider Demographics
NPI:1396958724
Name:DR. MARK H. JAFFE
Entity type:Organization
Organization Name:DR. MARK H. JAFFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-385-0775
Mailing Address - Street 1:375 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4323
Mailing Address - Country:US
Mailing Address - Phone:201-385-0775
Mailing Address - Fax:201-385-5375
Practice Address - Street 1:375 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4323
Practice Address - Country:US
Practice Address - Phone:201-385-0775
Practice Address - Fax:201-385-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ107971223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty