Provider Demographics
NPI:1861547051
Name:CHARLES PFEIFFER INC.
Entity type:Organization
Organization Name:CHARLES PFEIFFER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-447-6629
Mailing Address - Street 1:511 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2615
Mailing Address - Country:US
Mailing Address - Phone:718-447-6629
Mailing Address - Fax:718-273-4024
Practice Address - Street 1:511 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:718-447-6629
Practice Address - Fax:718-273-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
NY0763244335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG69511OtherEMPIRE BLUE CROSS BLUE SH
NY3400252OtherG.H.I.
NY00320618Medicaid
NY96363OtherAETNA
NY0215890001Medicare ID - Type Unspecified