MEDICARE: JANE M PONTERIO MD

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	207VG0400X	Gynecology Physician	150736	NY

General Provider Information

NPI Number	:	1669568226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE M PONTERIO MD

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	:	718-494-7420

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	:	718-494-7420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/20/2009

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