Provider Demographics
NPI:1083650329
Name:JAFFE, JOSHUA SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SAMUEL
Last Name:JAFFE
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 1:50 AMENIA RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2268
Mailing Address - Country:US
Mailing Address - Phone:860-364-0536
Mailing Address - Fax:860-364-1299
Practice Address - Street 1:50 AMENIA RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2268
Practice Address - Country:US
Practice Address - Phone:860-364-0536
Practice Address - Fax:860-364-1299
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167955207V00000X
CT025610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256106Medicaid
CTB83932Medicare UPIN
NY01256106Medicaid