Provider Demographics
NPI:1548322472
Name:HINESTROZA, HOWARD (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:HINESTROZA
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 1:45 RESEARCH WAY SUITE 105
Mailing Address - Street 2:STONY BROOK CHILDRENS SERVICES, UFPC
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3599
Mailing Address - Country:US
Mailing Address - Phone:631-675-2125
Mailing Address - Fax:631-675-2624
Practice Address - Street 1:285 W MAIN ST STE 104
Practice Address - Street 2:STONY BROOK PEDIATRICS OF SAYVILLE
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2540
Practice Address - Country:US
Practice Address - Phone:631-821-4202
Practice Address - Fax:631-821-7371
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03102518Medicaid