Basic Information
| Provider Information | |||||||||
| NPI: | 1780627695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PINEDA | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22581 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100872581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824795 | ||||||||
| FaxNumber: | 8565283117 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088073063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087222900 | ||||||||
| FaxNumber: | 9087221856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MB07154500 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | D080992 | 01 | NJ | CONTROLLED DANGEROUS SUB | OTHER | 8799709 | 05 | NJ | MEDICAID | 25MB07154500 | 01 | NJ | NJ MEDICAL LICENSE | OTHER | BP6774788 | 01 | FEDERAL DEA | OTHER |