Provider Demographics
NPI:1205022308
Name:PONTERIO & PESSOLANO, MD, PC
Entity Type:Organization
Organization Name:PONTERIO & PESSOLANO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PONTERIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-983-0204
Mailing Address - Street 1:1583 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1530
Mailing Address - Country:US
Mailing Address - Phone:718-983-0204
Mailing Address - Fax:
Practice Address - Street 1:1583 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1530
Practice Address - Country:US
Practice Address - Phone:718-983-0204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60246Medicare UPIN
NYW99711Medicare PIN
NY58F421Medicare PIN
NY06E591Medicare PIN
NYC09640Medicare UPIN