Provider Demographics
NPI:1740241389
Name:PFEFFER, MINDY SHERA (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:SHERA
Last Name:PFEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:SHERA
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:987 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3203
Mailing Address - Country:US
Mailing Address - Phone:631-864-9100
Mailing Address - Fax:631-864-9104
Practice Address - Street 1:987 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3203
Practice Address - Country:US
Practice Address - Phone:631-864-9100
Practice Address - Fax:631-864-9104
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160925-22085N0700X, 2085N0904X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY977161OtherBCBS
NY01067418Medicaid
NY01067418Medicaid