Provider Demographics
NPI:1467792267
Name:PEARL MEDICAL, PC
Entity Type:Organization
Organization Name:PEARL MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MILIVOJE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILOSEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-721-5515
Mailing Address - Street 1:3078 38TH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3805
Mailing Address - Country:US
Mailing Address - Phone:718-721-5515
Mailing Address - Fax:718-721-5531
Practice Address - Street 1:3078 38TH ST APT 1C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3805
Practice Address - Country:US
Practice Address - Phone:718-721-5515
Practice Address - Fax:718-721-5531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARL MEDICAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144052207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00533793Medicaid
NY00533793Medicaid