Basic Information
| Provider Information | |||||||||
| NPI: | 1063712198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PFEIFER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270-05 76TH AVENUE | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707390 | ||||||||
| FaxNumber: | 5164707307 | ||||||||
| Practice Location | |||||||||
| Address1: | 270-05 76TH AVENUE | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707390 | ||||||||
| FaxNumber: | 5164707307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2010 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 23-008853 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 002480 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.