Provider Demographics
NPI:1558420471
Name:PEARLSTEIN, ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:PEARLSTEIN
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 1:333 W 57TH ST APT 107
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3122
Mailing Address - Country:US
Mailing Address - Phone:212-873-2572
Mailing Address - Fax:212-873-2376
Practice Address - Street 1:333 W 57TH ST APT 107
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3122
Practice Address - Country:US
Practice Address - Phone:212-873-2572
Practice Address - Fax:212-873-2376
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01655449Medicaid
NY11314POtherHEALTH INS. PLAN OF NY
4C4509OtherHEALTHNET
5203209OtherAETNA
54S011OtherEMPIRE BLUE CROSS
41194208OtherMULTIPLAN
P430479OtherOXFORD HEALTH PLAN
1443156OtherUNITED HEALTH CARE
NY198390OtherLICENSE
NYG34499Medicare UPIN
P430479OtherOXFORD HEALTH PLAN