Provider Demographics
NPI:1003933813
Name:PEARL, JAMES BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRUCE
Last Name:PEARL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:B
Other - Last Name:PEARL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:185 MADISON AVENUE
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:646-270-3277
Mailing Address - Fax:212-586-1676
Practice Address - Street 1:185 MADISON AVENUE
Practice Address - Street 2:15TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:646-270-3277
Practice Address - Fax:212-586-1676
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000987-1102L00000X
NY1132171100000X
NY001132-1171100000X
NY1132-1171100000X
NY987-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No171100000XOther Service ProvidersAcupuncturist