Provider Demographics
NPI:1679820070
Name:REIDEL, PEARL (MS)
Entity Type:Individual
Prefix:MRS
First Name:PEARL
Middle Name:
Last Name:REIDEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 15TH AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3747
Mailing Address - Country:US
Mailing Address - Phone:718-972-3949
Mailing Address - Fax:
Practice Address - Street 1:5000 15TH AVE
Practice Address - Street 2:APT 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3747
Practice Address - Country:US
Practice Address - Phone:718-972-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program