Provider Demographics
NPI:1750260105
Name:PINCKNEY, BEVERLY J
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:PINCKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:J
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18427 145TH AVE APT PH
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3310
Mailing Address - Country:US
Mailing Address - Phone:347-728-1003
Mailing Address - Fax:
Practice Address - Street 1:18427 145TH AVE APT PH
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3310
Practice Address - Country:US
Practice Address - Phone:347-728-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator