Provider Demographics
NPI:1174605703
Name:PONIARSKI, RICHARD MINC (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MINC
Last Name:PONIARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 VALENTINES RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5840
Mailing Address - Country:US
Mailing Address - Phone:516-876-8451
Mailing Address - Fax:
Practice Address - Street 1:1966 VALENTINES RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5840
Practice Address - Country:US
Practice Address - Phone:516-876-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1850732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E95823Medicare UPIN