Provider Demographics
NPI:1376214825
Name:PINEDO, ERICK ANDRES
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:ANDRES
Last Name:PINEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BRADHURST AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2443
Mailing Address - Country:US
Mailing Address - Phone:718-937-0895
Mailing Address - Fax:
Practice Address - Street 1:130 BRADHURST AVE APT 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-2443
Practice Address - Country:US
Practice Address - Phone:718-937-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627675163W00000X
NY340989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY340989OtherNEW YORK STATE NURSE PRACTITIONER LICENSE