Provider Demographics
NPI:1982261582
Name:JAFRI, WAJIH HYDER (SPECIALIST ASSISTANT)
Entity Type:Individual
Prefix:
First Name:WAJIH
Middle Name:HYDER
Last Name:JAFRI
Suffix:
Gender:M
Credentials:SPECIALIST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 WINDWARD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1744
Mailing Address - Country:US
Mailing Address - Phone:917-862-5443
Mailing Address - Fax:718-939-1081
Practice Address - Street 1:893 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0368
Practice Address - Country:US
Practice Address - Phone:212-734-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO000206-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1427197755Medicaid