Provider Demographics
NPI:1871027151
Name:PINNOCK, NAHSTAJIA NICOLE JOY (MD)
Entity type:Individual
Prefix:
First Name:NAHSTAJIA
Middle Name:NICOLE JOY
Last Name:PINNOCK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 MARCUS AVE STE M6
Mailing Address - Street 2:
Mailing Address - City:NORTH NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2016
Mailing Address - Country:US
Mailing Address - Phone:217-363-6792
Mailing Address - Fax:
Practice Address - Street 1:1999 MARCUS AVE STE M6
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2016
Practice Address - Country:US
Practice Address - Phone:516-233-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.074731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program