Provider Demographics
NPI:1952635484
Name:PEARL, NAOMI C (MSE)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:C
Last Name:PEARL
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14119 71ST RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1944
Mailing Address - Country:US
Mailing Address - Phone:718-544-6442
Mailing Address - Fax:
Practice Address - Street 1:7238 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2408
Practice Address - Country:US
Practice Address - Phone:718-972-0880
Practice Address - Fax:718-997-7029
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1853654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist