Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jesubielin Custodio Peronilla, PT

Individual provider Physical Medicine & Rehabilitation Physician · NPI 1174338552

Mr. Jesubielin Custodio Peronilla, PT is a Physical Therapist in Private Practice in Astoria, New York. Qualified in 2015, 11 years ago. Practices with Fresh Pond Physical Therapy PC, a 13-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
11
Licensed in
NY
In the registry since
2025
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

3808 23rd Ave Apt 1F
Astoria, NY 11105-1963
Phone: (347) 350-1235
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence 050395 (NY)

Record details

NPI number1174338552
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorYes
NPI enumeratedFebruary 11, 2025
Last updated in NPPESFebruary 11, 2025
Certification dateFebruary 11, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Fresh Pond Physical Therapy Pc — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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