Provider Demographics
NPI:1417216888
Name:PINEDA, EDSON JESUS (APN)
Entity Type:Individual
Prefix:MR
First Name:EDSON
Middle Name:JESUS
Last Name:PINEDA
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1845
Mailing Address - Country:US
Mailing Address - Phone:201-436-4865
Mailing Address - Fax:201-823-1130
Practice Address - Street 1:714 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4759
Practice Address - Country:US
Practice Address - Phone:201-823-1313
Practice Address - Fax:201-823-1130
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00364500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health