Provider Demographics
NPI:1780612879
Name:JAFFE, BAILE
Entity type:Individual
Prefix:
First Name:BAILE
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 20 LITTLE NECK PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2530
Mailing Address - Country:US
Mailing Address - Phone:718-224-0566
Mailing Address - Fax:718-224-7544
Practice Address - Street 1:59-28 LITTLE NECK PARKWAY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-224-0566
Practice Address - Fax:718-224-7544
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013565-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1382663Medicaid
NY1382663Medicaid
NY70119AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NY7011DGMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER