Healthcare Provider Details

I. General information

NPI: 1942472535
Provider Name (Legal Business Name): JAMES VINCENT PRONESTI M.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ RM 157
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

52 SYDNEY AVE
MALVERNE NY
11565-1125
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-4366
  • Fax: 718-863-9743
Mailing address:
  • Phone: 203-997-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2171-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: