Provider Demographics
NPI:1851786602
Name:PEMPER, AVIGDOR (LP)
Entity Type:Individual
Prefix:
First Name:AVIGDOR
Middle Name:
Last Name:PEMPER
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GRAMERCY PARK S
Mailing Address - Street 2:#17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1707
Mailing Address - Country:US
Mailing Address - Phone:917-603-2479
Mailing Address - Fax:
Practice Address - Street 1:32 GRAMERCY PARK S
Practice Address - Street 2:#17A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1707
Practice Address - Country:US
Practice Address - Phone:917-603-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000934102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst