Jesubielin Custodio Peronilla, PT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

050395 Issued in NY

Practice address

3808 23Rd Ave Apt 1F
Astoria, NY 11105-1963

Phone

(347) 350-1235

NPI assigned

Feb 11, 2025

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fresh Pond Physical Therapy, P.C

  • Physical Therapy Clinic/Center
  • Ridgewood, NY
  • NPI 1508844036

  NY

  Medicare reassignment Care Compare group

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fresh Pond Physical Therapy PC 12 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

The complete record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1174338552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 23RD AVE APT 1F",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051963",
            "telephone_number": "347-350-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 23RD AVE APT 1F",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051963",
            "telephone_number": "347-350-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERONILLA",
        "first_name": "JESUBIELIN",
        "middle_name": "CUSTODIO",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-11",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "050395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leeat Perelmutter, LMSW
• Steve Anthony Perez-Padilla, SP. ED. THERAPIST
• Elizabeth M Perez
• Kathy Perez, CF-SLP
• Sandra M Perez
• Yakov Perper, MD
• Amy Sarika Persaud, PSYD
• Gianni Persich, D.P.M.
• Samarauh Person
• Natalia Pertuzyustes

• All providers in Astoria, NY
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.