Provider Demographics
NPI:1497938070
Name:PINEDO, VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:PINEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-5460
Mailing Address - Country:US
Mailing Address - Phone:917-703-7304
Mailing Address - Fax:
Practice Address - Street 1:192 ROUTE 117 BY PASS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-2146
Practice Address - Country:US
Practice Address - Phone:914-232-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55381208000000X
NY232329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497938070Medicaid