MEDICARE: DAVID R. PFAFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	162899	NY

General Provider Information

NPI Number	:	1639276447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R. PFAFF M.D.

Provider Business Mailing Address
First Line	:	3311 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3688
Country	:	US
Telephone Number	:	718-667-6776
Fax Number	:	718-980-1317

Provider Business Practice Location Address
First Line	:	420 LYNDALE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6131
Country	:	US
Telephone Number	:	718-667-6776
Fax Number	:	718-667-5461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/10/2019

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