Provider Demographics
NPI:1588670046
Name:POMP, ALFONS (MD)
Entity Type:Individual
Prefix:
First Name:ALFONS
Middle Name:
Last Name:POMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BOX 294
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:646-962-8462
Mailing Address - Fax:212-746-5236
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX 294
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:646-962-8462
Practice Address - Fax:212-746-5236
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223715208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH04451Medicare UPIN