Provider Demographics
NPI:1487665717
Name:PONDO, JAROSLAW S (MD)
Entity Type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:S
Last Name:PONDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 UNION AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1274
Mailing Address - Country:US
Mailing Address - Phone:201-896-0050
Mailing Address - Fax:201-896-0051
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07479000207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0185540Medicaid
NJ0185540Medicaid
NJ146822Medicare PIN