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General NPI Number Information
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NPI Number | 1487101226
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Entity Type | Organization
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Legal Business Name | JACQUELINE PONTICIELLO PSYCHIATRIC NP, PLLC
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/28/2024
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Provider Practice Location Address
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Address Line | 1901 VESTAL PKWY E STE 2W
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City | VESTAL
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State | NY
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Zip | 13850-1966
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Country | US
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Telephone | 607-341-4950
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Fax | 607-341-4933
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Provider Business Mailing Address
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Address Line | 1901 VESTAL PKWY E STE 2W
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City | VESTAL
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State | NY
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Zip | 13850-1966
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Country | US
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Telephone | 607-341-4950
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Fax | 607-341-4933
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE ANN PONTICIELLO
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Credential | NP
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Telephone | 607-341-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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