Provider Demographics
NPI:1073734349
Name:WEINSTEIN, PEARL A (PHD)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:A
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HILLSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-1917
Mailing Address - Country:US
Mailing Address - Phone:516-249-8243
Mailing Address - Fax:
Practice Address - Street 1:35 HILLSIDE ROAD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1917
Practice Address - Country:US
Practice Address - Phone:516-249-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007463 1103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV41861Medicare ID - Type Unspecified