Basic Information
Provider Information
NPI: 1003139130
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEARLROTH
FirstName: JEFFREY
MiddleName: STUART
NamePrefix: MR.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 162 WILDEY ST
Address2:  
City: TARRYTOWN
State: NY
PostalCode: 105912910
CountryCode: US
TelephoneNumber: 9143320567
FaxNumber: 9143320638
Practice Location
Address1: 162 WILDEY ST
Address2:  
City: TARRYTOWN
State: NY
PostalCode: 105912910
CountryCode: US
TelephoneNumber: 9143320567
FaxNumber: 9143320638
Other Information
ProviderEnumerationDate: 03/03/2010
LastUpdateDate: 03/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X031903INYY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home