Provider Demographics
NPI:1184823189
Name:PONDOK, THERESA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ELIZABETH
Last Name:PONDOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:914-377-0300
Mailing Address - Fax:914-327-2183
Practice Address - Street 1:1086 N BROADWAY STE 240
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1115
Practice Address - Country:US
Practice Address - Phone:914-751-3524
Practice Address - Fax:914-751-3525
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235764207UN0901X, 207RC0000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program