Provider Demographics
NPI:1407316912
Name:PONIROS, JULIA
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:PONIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3018
Mailing Address - Country:US
Mailing Address - Phone:914-652-6273
Mailing Address - Fax:
Practice Address - Street 1:1510 HENRY AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3018
Practice Address - Country:US
Practice Address - Phone:914-652-6273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist