NPIMap

Organization Active NPI

Jacqueline Ponticiello Psychiatric NP, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Vestal, NY
National Provider Identifier
1487101226
Registry record updated Sep 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
JACQUELINE PONTICIELLO PSYCHIATRIC NP, PLLC
Practice address
1901 Vestal Pkwy E Ste 2W
Vestal, NY 13850-1966
Phone
(607) 341-4950
Fax
(607) 341-4933
NPI assigned
Sep 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2024

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

Authorized official

Name
Jacqueline Ann Ponticiello, NPNPI 1588977763
Title
Owner
Phone
(607) 341-4950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1901 Vestal Pkwy E Ste 2W
Vestal, NY 13850-1966

Mailing address

1901 Vestal Pkwy E Ste 2W
Vestal, NY 13850-1966
Phone (607) 341-4950

Other names 1

  • Aspect Psychiatric Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250103001495 NY Part B Supplier - Clinic/Group Practice 2567990567 Receives reassigned benefits from 13 practitioners
Practice locations: Vestal, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2266821Jacqueline Ponticiello Psychiatric NP, PLLC1901 Vestal Parkway East, Suite 2W, Vestal, NY 13850Certificate of waiverAug 15, 2026

National Provider Directory

National Provider Directory

Locations

94 Marshall Dr
Endicott, NY 13760
Phone (607) 785-0400

1901 Vestal Pkwy E
Ste 2W
Vestal, NY 13850
Phone (607) 341-4950

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727481600000",
    "number": "1487101226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 VESTAL PKWY E STE 2W",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501966",
            "telephone_number": "607-341-4950",
            "fax_number": "607-341-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 VESTAL PKWY E STE 2W",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501966",
            "telephone_number": "607-341-4950",
            "fax_number": "607-341-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE PONTICIELLO PSYCHIATRIC NP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-09",
        "last_updated": "2024-09-28",
        "certification_date": "2024-09-28",
        "status": "A",
        "authorized_official_last_name": "PONTICIELLO",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-341-4950",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspect Psychiatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vestal, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2024; 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.