Provider Demographics
NPI:1407668114
Name:PINEIROS, CRYSTAL (PA)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:
Last Name:PINEIROS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BERRYMAN PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1907
Mailing Address - Country:US
Mailing Address - Phone:973-572-2689
Mailing Address - Fax:
Practice Address - Street 1:805 BERGEN TOWN CTR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5010
Practice Address - Country:US
Practice Address - Phone:201-965-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032220363A00000X
NJ25MP00817600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant