Provider Demographics
NPI:1285884841
Name:NAVARRETE FAUBLA, JAIME IGNACIO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:IGNACIO
Last Name:NAVARRETE FAUBLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 IVY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1627
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2071
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-737-8165
Practice Address - Fax:607-737-8175
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.144721207RH0003X
NY258375207RH0003X, 207RH0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03357820Medicaid
NYJ400063559Medicare PIN
NY03357820Medicaid
NY10712AMedicare PIN
NY70005AMedicare PIN