Individual
JACQUELINE ANN PONTICIELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP, FNP
Contact information
Practice address
1901 VESTAL PKWY E STE 2W, VESTAL, NY 13850-1966
(607) 341-4950
(607) 341-4933
Mailing address
1901 VESTAL PKWY E STE 2W, VESTAL, NY 13850-1966
(607) 341-4950
(607) 341-4933
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
F336411
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402886
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03240966
—
NY
Enumeration date
07/16/2010
Last updated
05/18/2023
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