Provider Demographics
NPI:1114077120
Name:PONDICHI, ANTONIO
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:PONDICHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BRONX RIVER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1720
Mailing Address - Country:US
Mailing Address - Phone:914-237-6089
Mailing Address - Fax:914-237-6099
Practice Address - Street 1:705 BRONX RIVER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1720
Practice Address - Country:US
Practice Address - Phone:914-237-6089
Practice Address - Fax:914-237-6099
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator