Provider Demographics
NPI:1205039351
Name:PEARL KORENBLIT MD LLC
Entity Type:Organization
Organization Name:PEARL KORENBLIT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KORENBLIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-928-5490
Mailing Address - Street 1:1011 CLIFTON AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3518
Mailing Address - Country:US
Mailing Address - Phone:973-928-5490
Mailing Address - Fax:973-928-5493
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ116699Medicare PIN