Healthcare Provider Details

I. General information

NPI: 1770691941
Provider Name (Legal Business Name): SAMUEL T PINOSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 110
NAPLES FL
34102-5886
US

IV. Provider business mailing address

PO BOX 26067
SALT LAKE CITY UT
84126-0067
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-3880
  • Fax: 239-624-3881
Mailing address:
  • Phone: 239-624-0400
  • Fax: 239-624-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0058754
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME58754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: