Provider Demographics
NPI:1417112459
Name:JAROSLAW S. PONDO, M.D. PC
Entity Type:Organization
Organization Name:JAROSLAW S. PONDO, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:S
Authorized Official - Last Name:PONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-896-0050
Mailing Address - Street 1:146 MORTIMER AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1615
Mailing Address - Country:US
Mailing Address - Phone:201-935-2087
Mailing Address - Fax:201-935-2087
Practice Address - Street 1:71 UNION AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1274
Practice Address - Country:US
Practice Address - Phone:201-896-0050
Practice Address - Fax:201-896-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07479000207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty