Healthcare Provider Details

I. General information

NPI: 1205219813
Provider Name (Legal Business Name): COURTNEY NICOLE PINEAU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 N JAMES ST
ROME NY
13440-2830
US

IV. Provider business mailing address

PO BOX 2000
EAST SYRACUSE NY
13057-4500
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-7284
  • Fax: 315-338-7286
Mailing address:
  • Phone: 315-362-5129
  • Fax: 315-362-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number300659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: