Provider Demographics
NPI:1295169845
Name:PINKSTON, LISA MARIE (MSOTR)
Entity type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LABRUZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:132 ROCKVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3721
Mailing Address - Country:US
Mailing Address - Phone:646-226-2135
Mailing Address - Fax:
Practice Address - Street 1:28-12 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3924
Practice Address - Country:US
Practice Address - Phone:201-475-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017807-1225X00000X
NJ46TR00604100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist