Provider Demographics
NPI:1417216888
Name:PINEDA, EDSON JESUS (APN)
Entity type:Individual
Prefix:MR
First Name:EDSON
Middle Name:JESUS
Last Name:PINEDA
Suffix:
Gender:M
Credentials:APN
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Other - First Name:
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Mailing Address - Street 1:654 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-6555
Mailing Address - Country:US
Mailing Address - Phone:609-890-1050
Mailing Address - Fax:609-890-0950
Practice Address - Street 1:654 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-6555
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:609-890-0950
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00364500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health