Provider Demographics
NPI:1487615050
Name:JAFFRY, SYED (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:JAFFRY
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:PO BOX 7140
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-7140
Mailing Address - Country:US
Mailing Address - Phone:908-353-6668
Mailing Address - Fax:732-603-0624
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-353-6608
Practice Address - Fax:732-603-0624
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67784207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8166706Medicaid
NJ036605Medicare ID - Type Unspecified
NJ8166706Medicaid