Provider Demographics
NPI:1255428546
Name:PFEIFER, TRACY MARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARLENE
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 5TH AVENUE
Mailing Address - Street 2:DOCTOR'S OFFICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-860-0670
Mailing Address - Fax:212-861-0677
Practice Address - Street 1:969 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0322
Practice Address - Country:US
Practice Address - Phone:212-860-0670
Practice Address - Fax:212-717-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192707208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG64539Medicare UPIN
37L391Medicare ID - Type Unspecified