1861547051 NPI number — CHARLES PFEIFFER INC.

Table of content: (NPI 1861547051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861547051 NPI number — CHARLES PFEIFFER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES PFEIFFER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861547051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 JEWETT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10302-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-447-6629
Provider Business Mailing Address Fax Number:
718-273-4024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 JEWETT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-447-6629
Provider Business Practice Location Address Fax Number:
718-273-4024
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALLEY
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-447-6629

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0763244 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 0763244 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G69511 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3400252 . This is a "G.H.I." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00320618 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96363 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".