Provider Demographics
NPI:1376694810
Name:PONTORIERO, DONNA A (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:A
Last Name:PONTORIERO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2735
Mailing Address - Country:US
Mailing Address - Phone:973-235-9393
Mailing Address - Fax:973-284-0059
Practice Address - Street 1:299 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2735
Practice Address - Country:US
Practice Address - Phone:973-235-9393
Practice Address - Fax:973-284-0059
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00544400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU75248Medicare UPIN
NJ027440Medicare ID - Type Unspecified