Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 058992 | NY |
Y | 1223D0004X | Dentist Anesthesiologist | 001230 | NY |
NPI | 1770902181 |
---|---|
Provider Name | David Pfeffer |
First Address | Valley Stream, NY 11581-3532 |
Second Address | Dix Hills, NY 11746-6340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 19/11/2019 |