Provider Demographics
NPI:1487017703
Name:PINARD, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 BELCREST RD
Mailing Address - Street 2:APT 1218
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2952
Mailing Address - Country:US
Mailing Address - Phone:561-542-5385
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5333
Practice Address - Country:US
Practice Address - Phone:862-766-5363
Practice Address - Fax:862-766-5364
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10845900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA10845900OtherPRIVATE INSURANCE
NJ25MA10845900Medicaid