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General NPI Number Information
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NPI Number | 1205039351
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Entity Type | Organization
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Legal Business Name | PEARL KORENBLIT MD LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 1011 CLIFTON AVE FIRST FLOOR
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City | CLIFTON
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State | NJ
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Zip | 07013-3518
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Country | US
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Telephone | 973-928-5490
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Fax | 973-928-5493
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Provider Business Mailing Address
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Address Line | 1011 CLIFTON AVE FIRST FLOOR
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City | CLIFTON
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State | NJ
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Zip | 07013-3518
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Country | US
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Telephone | 973-928-5490
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Fax | 973-928-5493
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PEARL KORENBLIT
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Credential | M.D.
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Telephone | 973-928-5490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 65102
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License Number State | NJ
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