Provider Demographics
NPI:1760490072
Name:PINO, CHRISTOPHER (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:PINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 HARRIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7403
Mailing Address - Country:US
Mailing Address - Phone:716-832-0010
Mailing Address - Fax:716-332-0237
Practice Address - Street 1:796 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1838
Practice Address - Country:US
Practice Address - Phone:716-832-0010
Practice Address - Fax:716-332-9237
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY056611Medicare ID - Type Unspecified