Healthcare Provider Details

I. General information

NPI: 1215943188
Provider Name (Legal Business Name): THERESA PINSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BROADWAY STE 1804
NEW YORK NY
10006-2560
US

IV. Provider business mailing address

5 EAGLE CHASE
WOODBURY NY
11797-2900
US

V. Phone/Fax

Practice location:
  • Phone: 212-430-6677
  • Fax: 212-430-6678
Mailing address:
  • Phone: 212-430-6677
  • Fax: 212-430-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number334906
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: