Provider Demographics
NPI:1043248131
Name:KORENBLIT, PEARL (MD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:
Last Name:KORENBLIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 PENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4645
Mailing Address - Country:US
Mailing Address - Phone:973-778-1682
Mailing Address - Fax:973-778-7233
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-928-5490
Practice Address - Fax:973-928-5493
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173985207R00000X
NJ65102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7206500Medicaid
NJF34071Medicare UPIN
NJ895434Medicare PIN