Individual provider Active NPI

Marie Angela Golez Bontigao

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1649890831
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
346591 Issued in NY
Practice address
7404 5TH Ave
Brooklyn, NY 11209-2704
Phone
(718) 439-5111
NPI assigned
Apr 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X 790334 NY
Emergency Registered Nurse 163WE0003X RN95490 NV
Emergency Registered Nurse 163WE0003X 830531 CA
Nurse Practitioner 363L00000X 95024033 CA
Family Nurse Practitioner 363LF0000X 346591 NY Primary

Addresses

Primary practice location

7404 5TH Ave
Brooklyn, NY 11209-2704

Mailing address

131 Dudley St Apt 507
Jersey City, NJ 07302-4661
Phone (310) 971-0674

Other practice location 1

1400 Pelham Pkwy S
Bronx, NY 10461-1138
Phone (718) 918-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201209001078 NY Practitioner - Nurse Practitioner 2062824493 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
84917CAMDMarriage & Family Therapist
RN95490NVMDEmergency Registered Nurse
790334NYMDEmergency Registered Nurse
95024033CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Emergency Physicians Medical Group CurrentSince Aug 4, 2022 Accepting new patients
Parcare Community Health Network Inc CurrentSince Oct 1, 2020 Accepting new patients
Parcare Community Health Network Inc CurrentSince Oct 1, 2020 Accepting new patients

Locations

3865 Jackson St
Riverside, CA 92503
Phone (909) 688-2211

445 Park Ave
Brooklyn, NY 11205
Phone (718) 965-1320

6010 Bay Pkwy
Ste 901
Brooklyn, NY 11204
Phone (718) 238-2100

4401 W Memorial Rd
Ste 121
Oklahoma City, OK 73134
Phone (405) 749-4560

Interoperability endpoints

  • Direct secure messaging: marie.bontigao.p2@direct.hvvmg.nextgenshare.com
  • Direct secure messaging: marie.angela.bontigao.1@25843.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1649890831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 DUDLEY ST APT 507",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024661",
            "telephone_number": "310-971-0674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7404 5TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112092704",
            "telephone_number": "718-439-5111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Pelham Pkwy S",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104611138",
            "country_code": "US",
            "telephone_number": "718-918-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONTIGAO",
        "first_name": "MARIE ANGELA",
        "middle_name": "GOLEZ",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "NY",
            "license": "790334",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "NV",
            "license": "RN95490",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CA",
            "license": "830531",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95024033",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.