Provider Demographics
NPI:1639276447
Name:PFAFF, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:PFAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3311 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3688
Mailing Address - Country:US
Mailing Address - Phone:718-667-6776
Mailing Address - Fax:718-980-1317
Practice Address - Street 1:420 LYNDALE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6131
Practice Address - Country:US
Practice Address - Phone:718-667-6776
Practice Address - Fax:718-667-5461
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY162899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63285Medicare UPIN
NY56D391Medicare ID - Type Unspecified