Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | X004179 | NY |
N | 111NN0400X | Neurology | X004179 | NY |
N | 111NS0005X | Chiropractic Sports Physician | X004179 | NY |
NPI | 1619027455 |
---|---|
Provider Name | Dr. Joseph E Pfeifer |
First Address | Lake Grove, NY 11755-1601 |
Second Address | Lake Grove, NY 11755-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025707 | AETNA (01) | NY |
125619 | ACN (01) | NY |
26904 | GHI (01) | NY |
C04179-0 | WORKERS' COMP (01) | NY |
SF00000371 | SELECT PRO (01) | NY |
U36891 | (02) | |
X8851 | BLUE CHOICE (01) | NY |