Provider Demographics
NPI: | 1619985314 |
---|---|
Name: | PINKUS, HARRY E (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HARRY |
Middle Name: | E |
Last Name: | PINKUS |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 13505 CITICARDS WAY UNIT 4302 |
Mailing Address - Street 2: | |
Mailing Address - City: | JACKSONVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32258-6539 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 207-522-2990 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 15 NORTHRIDGE DR |
Practice Address - Street 2: | |
Practice Address - City: | HILTON HEAD ISLAND |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29926-3764 |
Practice Address - Country: | US |
Practice Address - Phone: | 207-522-2990 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-08-04 |
Last Update Date: | 2020-12-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME57105 | 2085N0700X, 2085R0202X, 2085R0202X |
NJ | 25MA08135800 | 2085N0700X, 2085R0202X |
VA | 0101840461 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
E79513 | Medicare UPIN |