Basic Information
Provider Information | |||||||||
NPI: | 1235206962 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCCAFFREY | ||||||||
FirstName: | JANE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 NORTH ST | ||||||||
Address2: | SUITE 101 | ||||||||
City: | GENEVA | ||||||||
State: | NY | ||||||||
PostalCode: | 144561561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3157875200 | ||||||||
FaxNumber: | 3157875221 | ||||||||
Practice Location | |||||||||
Address1: | 200 NORTH ST | ||||||||
Address2: | SUITE 101 | ||||||||
City: | GENEVA | ||||||||
State: | NY | ||||||||
PostalCode: | 144561561 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3157875100 | ||||||||
FaxNumber: | 3157875108 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/29/2006 | ||||||||
LastUpdateDate: | 11/29/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 115848 | NY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 449183 | 05 | NY |   | MEDICAID | P010115848 | 01 | NY | BLUE SHIELD | OTHER | 102193DL | 01 | NY | PREFERRED CARE | OTHER | 2697337 | 01 | NY | GHI | OTHER | P010115848 | 01 | NY | BLUE CHOICE | OTHER |