Provider Demographics
NPI:1780627695
Name:PINEDA, JEAN H (DO)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:H
Last Name:PINEDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:215 UNION AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3063
Practice Address - Country:US
Practice Address - Phone:908-722-2900
Practice Address - Fax:908-722-1856
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07154500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD080992OtherCONTROLLED DANGEROUS SUB
NJ8799709Medicaid
NJ25MB07154500OtherNJ MEDICAL LICENSE
BP6774788OtherFEDERAL DEA
NJ8799709Medicaid
057492Medicare ID - Type UnspecifiedMEDICARE