Provider Demographics
NPI:1952310336
Name:PINERO-BERNARDO, SHIRLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:J
Last Name:PINERO-BERNARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4500 PARSONS BOULEVARD
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2205
Mailing Address - Country:US
Mailing Address - Phone:718-670-5751
Mailing Address - Fax:718-670-3031
Practice Address - Street 1:4500 PARSONS BLVD
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2205
Practice Address - Country:US
Practice Address - Phone:718-670-5751
Practice Address - Fax:718-670-3031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07806700208000000X
NY233472208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02825258Medicaid
NJI18754Medicare UPIN
NY02825258Medicaid