Provider Demographics
NPI:1114967486
Name:JAFFRI, MOHAMMAD T (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:T
Last Name:JAFFRI
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 1:8162 GOLDEN OAK CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8502
Mailing Address - Country:US
Mailing Address - Phone:716-688-6309
Mailing Address - Fax:
Practice Address - Street 1:1263 DELAWARE AVENUE
Practice Address - Street 2:BRYLIN HOSPITALS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-886-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0110490OtherINDEPENDENT HEALTH
NY00010303802OtherUNIVERA
NY000524685004OtherBLUE CROSS
NY01775740Medicaid
NY00010303802OtherUNIVERA
NYP00211597Medicare PIN
NYG36985Medicare UPIN