Ponticiello, Jacqueline Ann

Ponticiello, Jacqueline Ann is an sole proprietor health care provider with primary practice located at 1901 Vestal Pkwy E Ste 2W , Vestal NY 13850-1966. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Ponticiello, Jacqueline Ann can be contacted via phone (607) 341-4950.

Contact Information

Primary practice address
1901 Vestal Pkwy E Ste 2W Vestal NY 13850-1966
Phone: (607) 341-4950
Fax: (607) 341-4933
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F336411 New York
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 402886 New York

Profile Details

NPI number 1588977763
LBN Legal business name Ponticiello, Jacqueline Ann
Credentials NPP, FNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 16th, 2010
Last updated May 18th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588977763 NPPES
New York MEDICAID 03240966

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