Provider Demographics
NPI:1821186743
Name:PIERINO, MARK P (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:PIERINO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 NORTH UNION ROAD
Mailing Address - Street 2:NORTHTOWNS ORTHOPEDICS, PC
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-636-1470
Mailing Address - Fax:716-636-1423
Practice Address - Street 1:8750 TRANSIT ROAD
Practice Address - Street 2:NORTHTOWNS ORTHOPEDICS, PC, SUITE 105
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051
Practice Address - Country:US
Practice Address - Phone:716-636-1470
Practice Address - Fax:716-636-1423
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007729363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02343057Medicaid
NYP21149Medicare UPIN
NYPA0928Medicare ID - Type Unspecified