Provider Demographics
NPI:1356802714
Name:PEARL-ABBONDANDOLO, GENNA LORYN (MD)
Entity type:Individual
Prefix:DR
First Name:GENNA
Middle Name:LORYN
Last Name:PEARL-ABBONDANDOLO
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 1:28 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-4030
Mailing Address - Country:US
Mailing Address - Phone:917-324-7080
Mailing Address - Fax:
Practice Address - Street 1:GENERAL PEDIATRICS AT GLEN COVE
Practice Address - Street 2:1 SCHOOL STREET, SUITE 203
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-676-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty