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General NPI Number Information
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NPI Number | 1023363561
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Entity Type | Individual
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Provider Name | KRISTOFFERSON M PINEDA ANP - BC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 350 ENGLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1898
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Country | US
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Telephone | 201-894-3908
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Fax |
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Provider Business Mailing Address
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Address Line | 11 REVERE PL
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City | TAPPAN
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State | NY
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Zip | 10983-1016
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Country | US
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Telephone | 845-461-5233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00459700
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License Number State | NJ
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