Provider Demographics
NPI:1871588780
Name:REBECCA JAFFE AND ASSOCIATES PA
Entity type:Organization
Organization Name:REBECCA JAFFE AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-992-0200
Mailing Address - Street 1:3105 LIMESTONE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2156
Mailing Address - Country:US
Mailing Address - Phone:302-992-0200
Mailing Address - Fax:302-992-9282
Practice Address - Street 1:3105 LIMESTONE RD STE 301
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2156
Practice Address - Country:US
Practice Address - Phone:302-992-0200
Practice Address - Fax:302-992-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE975464163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510279425OtherBLUE CROSS BLUE SHIELD DE
DE0000210202Medicaid
DE78517OtherAETNA US HEALTHCARE
DE=========OtherMAMSI OPTIMUM CHOICE
DE78517OtherAETNA US HEALTHCARE
DE=========OtherAETNA US HEALTHCARE
DE78517OtherAETNA US HEALTHCARE
DE610317Medicare PIN