Provider Demographics
NPI:1477594323
Name:PINA, RALPH JULIO (NP)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:JULIO
Last Name:PINA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E 76TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3104
Mailing Address - Country:US
Mailing Address - Phone:212-434-5393
Mailing Address - Fax:
Practice Address - Street 1:416 E 76TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3104
Practice Address - Country:US
Practice Address - Phone:212-434-5393
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400432363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01907299Medicaid
NY01907299Medicaid
S57629Medicare UPIN