Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 111111 | NY |
NPI | 1730400169 |
---|---|
Provider Name | Dr. Bruce Alan Pfeffer |
First Address | Fairport, NY 14450-2920 |
Second Address | Fairport, NY 14450-2920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1111111111 | VA-WNY HEALTHCARE SYSTEM (01) | NY |