Provider Demographics
NPI:1487744223
Name:PINEDA, VERONICA VARGAS (DO)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:VARGAS
Last Name:PINEDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3704
Mailing Address - Country:US
Mailing Address - Phone:201-823-1313
Mailing Address - Fax:201-823-1130
Practice Address - Street 1:546 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3704
Practice Address - Country:US
Practice Address - Phone:201-823-1313
Practice Address - Fax:201-823-1130
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07208300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0110019Medicaid
NJ7560377OtherCIGNA ID
NJH57346Medicare UPIN
NJ056294Medicare ID - Type UnspecifiedMEDICARE PROVIDER