Provider Demographics
NPI:1477562007
Name:JAFRI, JAFFAR M (MD)
Entity type:Individual
Prefix:
First Name:JAFFAR
Middle Name:M
Last Name:JAFRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAFFAR
Other - Middle Name:MEHDI
Other - Last Name:JAFRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:44 FOREST GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-6804
Mailing Address - Country:US
Mailing Address - Phone:732-583-1345
Mailing Address - Fax:
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-429-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08099100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0120341Medicaid
NJP00663671OtherRAILROAD MEDICARE
NJ110418SNYMedicare PIN
NJP00663671OtherRAILROAD MEDICARE