MEDICARE: PEARL WEILL PA-C

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	363A00000X	Physician Assistant	016325-1	NY

General Provider Information

NPI Number	:	1245571850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL WEILL PA-C

Provider Business Mailing Address
First Line	:	1592 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6710
Country	:	US
Telephone Number	:	718-627-9240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1592 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6710
Country	:	US
Telephone Number	:	718-627-9240
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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Directions to “ PEARL WEILL PA-C” Practice Location

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