Provider Demographics
NPI:1225303258
Name:STEVEN W. PRUFER, P.C.
Entity Type:Organization
Organization Name:STEVEN W. PRUFER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PRUFER
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:718-271-8775
Mailing Address - Street 1:6120 GRAND CENTRAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1263
Mailing Address - Country:US
Mailing Address - Phone:718-271-8775
Mailing Address - Fax:
Practice Address - Street 1:6120 GRAND CENTRAL PARKWAY
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1263
Practice Address - Country:US
Practice Address - Phone:718-271-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty