Active NPI
Pearl Ketover Prilik, DSW
- Clinical Social Worker
- Garden City, NY
National Provider Identifier
1215088596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R044788-1
- Practice address
- 647 Franklin Ave
Garden City, NY 11530-5746 - Phone
- (516) 873-1234
- Fax
- (516) 873-1234
- NPI assigned
- Jan 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R044788-1 | NY | Primary |
Addresses
Primary practice location
647 Franklin Ave
Garden City, NY 11530-5746
Mailing address
930 Gerry Ave
Lido Beach, NY 11561-5217
Phone (516) 873-1234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AS1548 | Other | NY | OXFORD INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R044788-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215088596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 GERRY AVE",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115615217",
"telephone_number": "516-873-1234",
"fax_number": "516-873-1234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "647 FRANKLIN AVE",
"city": "GARDEN CITY",
"state": "NY",
"postal_code": "115305746",
"telephone_number": "516-873-1234",
"fax_number": "516-873-1234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETOVER PRILIK",
"first_name": "PEARL",
"name_prefix": "Dr.",
"credential": "DSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R044788-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD INSURANCE",
"identifier": "AS1548",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garden City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.