Provider Demographics
NPI:1124563499
Name:PINNOCK, AKILAH
Entity Type:Individual
Prefix:
First Name:AKILAH
Middle Name:
Last Name:PINNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2401
Mailing Address - Country:US
Mailing Address - Phone:631-372-9071
Mailing Address - Fax:
Practice Address - Street 1:15 N 10TH ST
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2401
Practice Address - Country:US
Practice Address - Phone:631-372-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician