Provider Demographics
NPI:1548400195
Name:PONTIPIEDRA, ALLAN (APN, C)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:PONTIPIEDRA
Suffix:
Gender:M
Credentials:APN, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 CHARLTON CIR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1481
Mailing Address - Country:US
Mailing Address - Phone:732-914-1754
Mailing Address - Fax:
Practice Address - Street 1:1886 CHARLTON CIR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1481
Practice Address - Country:US
Practice Address - Phone:732-914-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10479100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily