Provider Demographics
NPI:1083945174
Name:MAFFEI, FRED B (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:B
Last Name:MAFFEI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PARK DR N
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5702
Mailing Address - Country:US
Mailing Address - Phone:718-698-2180
Mailing Address - Fax:718-828-7491
Practice Address - Street 1:2941 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4534
Practice Address - Country:US
Practice Address - Phone:718-823-1085
Practice Address - Fax:718-828-7491
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist