Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA02930800 | NJ |
NPI | 1063526168 |
---|---|
Provider Name | Dr. Syed Moosa Jaffari |
First Address | Lakewood, NJ 08701 |
Second Address | Lakewood, NJ 08701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 14/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3001601 | (05) | NJ |
C52947 | (02) |