Provider Demographics
NPI:1932232808
Name:PINNOCK, RICHARD S (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:PINNOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8759 171ST ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4554
Mailing Address - Country:US
Mailing Address - Phone:718-291-4111
Mailing Address - Fax:718-291-5042
Practice Address - Street 1:8759 171ST ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4554
Practice Address - Country:US
Practice Address - Phone:718-291-4111
Practice Address - Fax:718-291-5042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004829213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01239665Medicaid
NY00233AMedicare ID - Type UnspecifiedGHI-MEDICARE
NY01239665Medicaid