Provider Demographics
NPI:1538664123
Name:PINO, HARRY (PHD, TPI, EPC)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:PINO
Suffix:
Gender:M
Credentials:PHD, TPI, EPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3214
Mailing Address - Country:US
Mailing Address - Phone:845-986-5099
Mailing Address - Fax:
Practice Address - Street 1:214 WEST ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3214
Practice Address - Country:US
Practice Address - Phone:845-986-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN232224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141830576OtherCOMMERCIAL