Provider Demographics
NPI:1386862696
Name:MICHELLE PFEFFER
Entity Type:Organization
Organization Name:MICHELLE PFEFFER
Other - Org Name:AXIS II CHIROPRACTIC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PFEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-520-5026
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-0037
Mailing Address - Country:US
Mailing Address - Phone:516-520-7200
Mailing Address - Fax:516-520-5026
Practice Address - Street 1:150 GARDINERS AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3707
Practice Address - Country:US
Practice Address - Phone:516-520-5026
Practice Address - Fax:516-520-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007602-1111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4578840001Medicare NSC
NYU58327Medicare UPIN