Provider Demographics
NPI:1063526168
Name:JAFFARI, SYED MOOSA (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:MOOSA
Last Name:JAFFARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-367-7707
Mailing Address - Fax:732-367-7860
Practice Address - Street 1:814 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-7707
Practice Address - Fax:732-367-7860
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02930800207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3001601Medicaid
C52947Medicare UPIN
NJ3001601Medicaid