MEDICARE: PONTERIO & PESSOLANO, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	150736	NY

General Provider Information

NPI Number	:	1205022308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONTERIO & PESSOLANO, MD, PC

Provider Business Mailing Address
First Line	:	1583 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1530
Country	:	US
Telephone Number	:	718-983-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	1583 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1530
Country	:	US
Telephone Number	:	718-983-0204
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANE M PONTERIO
Credential	:	M.D.
Telephone Number	:	718-983-0204

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	12/27/2007

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