Provider Demographics
NPI:1851431100
Name:PEARLMUTTER, BETH (OD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:PEARLMUTTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:RIFKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:819 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-1109
Mailing Address - Country:US
Mailing Address - Phone:914-763-5689
Mailing Address - Fax:
Practice Address - Street 1:7220 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5355
Practice Address - Country:US
Practice Address - Phone:718-261-0739
Practice Address - Fax:718-261-8643
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03153Medicare ID - Type Unspecified
NYU49497Medicare UPIN