Healthcare Provider Details

I. General information

NPI: 1811071848
Provider Name (Legal Business Name): GARY R PEARLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8214 18TH AVE
BROOKLYN NY
11214-2901
US

IV. Provider business mailing address

8214 18TH AVE
BROOKLYN NY
11214-2901
US

V. Phone/Fax

Practice location:
  • Phone: 718-331-3939
  • Fax: 718-331-4321
Mailing address:
  • Phone: 718-331-3939
  • Fax: 718-331-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number155908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: