Provider Demographics
NPI:1033629357
Name:PINOS, RENELLE VELEZ
Entity Type:Individual
Prefix:
First Name:RENELLE
Middle Name:VELEZ
Last Name:PINOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENELLE
Other - Middle Name:LOURDES
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:46 KNICKERBOCKER ROAD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1919
Mailing Address - Country:US
Mailing Address - Phone:201-784-9420
Mailing Address - Fax:
Practice Address - Street 1:46 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-1919
Practice Address - Country:US
Practice Address - Phone:201-784-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00714800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00714800OtherSTATE OF NJ BOARD OF NURSING
NY476949-1OtherSTATE OF NY EDUCATION DEPT. OFFICE OF THE PROFESSIONS