Provider Demographics
NPI:1568481000
Name:PINO, EDWARD H (MS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:H
Last Name:PINO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:H
Other - Last Name:PINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:6820 BURNS ST APT A4
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5080
Mailing Address - Country:US
Mailing Address - Phone:646-734-7114
Mailing Address - Fax:
Practice Address - Street 1:98120 QUEENS BLVD
Practice Address - Street 2:CCC
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4357
Practice Address - Country:US
Practice Address - Phone:718-830-0246
Practice Address - Fax:718-830-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health