Provider Demographics
NPI:1235823766
Name:PHEIFFER, JEREMY (LMT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:PHEIFFER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COLUMBIA PL APT B045
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4591
Mailing Address - Country:US
Mailing Address - Phone:917-415-8588
Mailing Address - Fax:
Practice Address - Street 1:SPACE FOR WELLNESS
Practice Address - Street 2:52 E11TH ST GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6001
Practice Address - Country:US
Practice Address - Phone:347-509-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist