Healthcare Provider Details

I. General information

NPI: 1982979639
Provider Name (Legal Business Name): CHARLES J PEARLMAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 BRIGHTON BEACH AVE STE 2
BROOKLYN NY
11235-5621
US

IV. Provider business mailing address

1009 BRIGHTON BEACH AVE STE 2
BROOKLYN NY
11235-5621
US

V. Phone/Fax

Practice location:
  • Phone: 718-715-4114
  • Fax: 718-734-2985
Mailing address:
  • Phone: 718-715-4114
  • Fax: 718-734-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number188085
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA LUNGIN
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 718-715-4114