Healthcare Provider Details

I. General information

NPI: 1508829540
Provider Name (Legal Business Name): DEBORAH MARIE PONTORIERO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NEW RD STE D4
LINWOOD NJ
08221-1050
US

IV. Provider business mailing address

2099 NEW ALBANY RD
CINNAMINSON NJ
08077-3534
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-6474
  • Fax: 99-266-4746
Mailing address:
  • Phone: 609-926-8899
  • Fax: 856-772-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberP26NRO540890
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NN05408900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: