Provider Demographics
NPI:1508168535
Name:PONE, ENTELA (MD)
Entity Type:Individual
Prefix:
First Name:ENTELA
Middle Name:
Last Name:PONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2639
Mailing Address - Country:US
Mailing Address - Phone:716-381-9046
Mailing Address - Fax:716-436-3187
Practice Address - Street 1:832 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2639
Practice Address - Country:US
Practice Address - Phone:716-381-9046
Practice Address - Fax:716-436-3187
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272508207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400235162OtherMEDICARE NUMBER