Provider Demographics
NPI:1164451217
Name:ANDREW D PEARLE MD PC
Entity Type:Organization
Organization Name:ANDREW D PEARLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PEARLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-146-7526
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:212-146-7526
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:STARR 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-7526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216333207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY679F8OtherEMPIRE BLUE CROSS
NYP3624045OtherOXFORD
NYP3624045OtherOXFORD
NY679F8OtherEMPIRE BLUE CROSS