Healthcare Provider Details

I. General information

NPI: 1982683025
Provider Name (Legal Business Name): DAVID J PINNELAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 STATE ROUTE 33 SUITE 4B
NEPTUNE NJ
07753-4860
US

IV. Provider business mailing address

1820 STATE ROUTE 33 SUITE 4B
NEPTUNE NJ
07753-4860
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-8500
  • Fax: 732-988-2347
Mailing address:
  • Phone: 732-776-8500
  • Fax: 732-988-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA05743000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA05743000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA05743000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: