Healthcare Provider Details

I. General information

NPI: 1194651679
Provider Name (Legal Business Name): JENNA MARIE PONTO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7449 MORGAN RD
LIVERPOOL NY
13090-3973
US

IV. Provider business mailing address

7449 MORGAN RD
LIVERPOOL NY
13090-3973
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-5400
  • Fax:
Mailing address:
  • Phone: 315-451-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359960-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: