Healthcare Provider Details

I. General information

NPI: 1740386093
Provider Name (Legal Business Name): IVY L PEARLSTEIN APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WIGGINS ST
PRINCETON NJ
08540-6914
US

IV. Provider business mailing address

301 WEXLEY DR
NEWTOWN PA
18940-1663
US

V. Phone/Fax

Practice location:
  • Phone: 609-683-5155
  • Fax: 609-683-9507
Mailing address:
  • Phone: 215-579-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNN55303
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: