Provider Demographics
NPI:1740384932
Name:PEARL, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:PEARL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45 TERRY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-265-4485
Mailing Address - Fax:631-265-3620
Practice Address - Street 1:45 TERRY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-4485
Practice Address - Fax:631-265-3620
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2014-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1040052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B78455Medicare UPIN
NY632521Medicare ID - Type Unspecified