Basic Information
| Provider Information | |||||||||
| NPI: | 1588942056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAFFERANY PSYCHIATRIC SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3785 BAY RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
| FaxNumber: | 9897911392 | ||||||||
| Practice Location | |||||||||
| Address1: | 3055 HALLMARK CT | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486036825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897905990 | ||||||||
| FaxNumber: | 9897905991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2011 | ||||||||
| LastUpdateDate: | 06/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | JAFFERANY | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9897905990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | 1811008139 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.