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Individual

MICHAEL PONTICELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2001 NJ 37E, TOMS RIVER, NJ 08753
(732) 288-9322
Mailing address
150 BRICK BLVD, BRICK, NJ 08723-7182

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CPRS-50396
NJ

Other

Enumeration date
02/15/2023
Last updated
02/15/2023
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