Brenda Jean Pontillo, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704188594 Issued in MI

Practice address

21 Audubon Ave
New York, NY 10032-2275

Phone

(929) 715-3632

NPI assigned

Mar 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Downriver Mental Health Clinic PC

  • Psychologist
  • Taylor, MI
  • NPI 1295866135
  Medicare reassignment NPD
• Downriver Mental Health Clinic PC

  • Psychologist
  • Taylor, MI
  • NPI 1104930130
  NPD
• Wonder Years Psychiatric Services PLLC

  • Child & Adolescent Psychiatry Physician
  • Brooklyn, NY
  • NPI 1972046795
  NPD (past)
• Wonder Years Psychiatric Services of New Jersey PC

  • Psychiatry Physician
  • Morristown, NJ
  • NPI 1255028312
  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1699809541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 FORT WASHINGTON AVE APT 46",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321248",
            "telephone_number": "734-883-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 AUDUBON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100322275",
            "telephone_number": "929-715-3632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26 Court St Ste 816",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112421108",
            "country_code": "US",
            "telephone_number": "347-987-4233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PONTILLO",
        "first_name": "BRENDA",
        "middle_name": "JEAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704188594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anastasiya Ponomaryova
• Adam Pont, MD
• Antonio Pontecorvi, PTA
• Anamaria Pontes, MS, RD, CDN
• Taciana Pontier
• Allison Teresa Pontius, M.D.
• Fabio Ponzo, M.D.
• Pooja Sheth MD, PLLC
• Chinnachart Poola-Or
• Doran Pooladi

• Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.