Provider Demographics
NPI:1598761421
Name:LAFARGUE, ELLEN PFEFFER (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:PFEFFER
Last Name:LAFARGUE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROADWAY
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1607
Mailing Address - Country:US
Mailing Address - Phone:917-305-7755
Mailing Address - Fax:917-305-7819
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10004-3810
Practice Address - Country:US
Practice Address - Phone:917-305-7751
Practice Address - Fax:917-305-7770
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00043100231H00000X
NY000779-1231H00000X
NY14000002858231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM21831Medicare ID - Type Unspecified