Provider Demographics
NPI:1740386093
Name:PEARLSTEIN, IVY L (APN-C)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:L
Last Name:PEARLSTEIN
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1663
Mailing Address - Country:US
Mailing Address - Phone:215-579-9112
Mailing Address - Fax:
Practice Address - Street 1:21 WIGGINS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6914
Practice Address - Country:US
Practice Address - Phone:609-683-5155
Practice Address - Fax:609-683-9507
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN55303363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health