Provider Demographics
NPI:1801060447
Name:JAFFE, MINDY L (MINDY JAFFE, PNP)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:L
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MINDY JAFFE, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 96TH ST APT 12C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3945
Mailing Address - Country:US
Mailing Address - Phone:917-488-8660
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:917-488-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550958163W00000X
NYF381946-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse