Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 196680 | NY |
NPI | 1043219512 |
---|---|
Provider Name | Dr. Michael L. Pearl |
First Address | Stony Brook, NY 11790 |
Second Address | Stony Brook, NY 11790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 23/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E70462 | (02) | NY |