Provider Demographics
NPI:1306936208
Name:PINON, MIRIAM W (RNP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:W
Last Name:PINON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 RICH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2221
Mailing Address - Country:US
Mailing Address - Phone:718-920-5224
Mailing Address - Fax:718-601-8390
Practice Address - Street 1:MMC - FAMILY CARE CENTER 3RD
Practice Address - Street 2:3444 KOSSUTH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner