Provider Demographics
NPI:1760440747
Name:TIN, NINI (MD)
Entity Type:Individual
Prefix:DR
First Name:NINI
Middle Name:
Last Name:TIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3610
Mailing Address - Country:US
Mailing Address - Phone:914-747-6047
Mailing Address - Fax:914-747-6047
Practice Address - Street 1:VA HUDSON VALLEY HCS, PM&R/SCI SERVICES
Practice Address - Street 2:ROUTE 9, CASTLE POINT CAMPUS
Practice Address - City:CASTLE POINT
Practice Address - State:NY
Practice Address - Zip Code:12511
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:845-838-5184
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227352208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02427654Medicaid
NYI 00378Medicare UPIN
NY02427654Medicaid