Provider Demographics
NPI:1477326601
Name:PONTE, ISAAC DAVID (NJ-LSW, NY-LMSW)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:DAVID
Last Name:PONTE
Suffix:
Gender:M
Credentials:NJ-LSW, NY-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3138
Mailing Address - Country:US
Mailing Address - Phone:732-497-2826
Mailing Address - Fax:
Practice Address - Street 1:595 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3138
Practice Address - Country:US
Practice Address - Phone:732-497-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9540791041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool