Provider Demographics
NPI:1699004242
Name:PINO, EAN MATTHEW (LPN)
Entity Type:Individual
Prefix:
First Name:EAN
Middle Name:MATTHEW
Last Name:PINO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BEDFORD AVE APT 24G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2654
Mailing Address - Country:US
Mailing Address - Phone:917-881-0606
Mailing Address - Fax:
Practice Address - Street 1:1700 BEDFORD AVE APT 24G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2654
Practice Address - Country:US
Practice Address - Phone:917-881-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298941164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse