Jack Edward Yoffa, M.D.

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

106115-1 Issued in NY

Practice address

824 Franklin Park Dr
East Syracuse, NY 13057-1614

Phone

(315) 432-1048

Fax

(315) 432-9219

NPI assigned

Aug 15, 2006

Reactivated

Jan 6, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• David M. Girardi, OD, LLC

  • Optometrist
  • East Syracuse, NY
  • NPI 1972916096
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1194838334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 FRANKLIN PARK DR",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571614",
            "telephone_number": "315-432-1048",
            "fax_number": "315-432-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 FRANKLIN PARK DR",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571614",
            "telephone_number": "315-432-1048",
            "fax_number": "315-432-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOFFA",
        "first_name": "JACK",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2016-01-06",
        "deactivation_date": "2015-12-04",
        "reactivation_date": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "106115-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00572349",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Wilson Wormuth, M.D., M.P.H.
• Amanda W. Wright, MS
• Edward J Wyluda, D.O.
• Pamela Yager, NP
• Jill Kathleen Yeager, D.O.
• Jennifer Christine Young, OTR/L
• Rachael Zabycz, PA
• Allyson Marie Zakrzewski, M.D.
• Ashley F Zalewski, NO
• Sarah Zaremba, M.S. CCC-SLP

• Legal Medicine in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Legal Medicine in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.