Provider Demographics
NPI:1710097589
Name:PONESSA, BRENDA C (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:C
Last Name:PONESSA
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 1:64 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:845-457-5655
Practice Address - Street 1:64 UNION ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549
Practice Address - Country:US
Practice Address - Phone:845-457-1015
Practice Address - Fax:845-457-5655
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor