Provider Demographics
NPI:1740200021
Name:KELEMEN, POND R
Entity Type:Individual
Prefix:
First Name:POND
Middle Name:R
Last Name:KELEMEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ASHFORD AVE
Mailing Address - Street 2:COMMUNITY HOSPITAL @ DOBBS FERRY
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:914-693-5025
Mailing Address - Fax:914-693-6351
Practice Address - Street 1:128 ASHFORD AVE
Practice Address - Street 2:COMMUNITY HOSPITAL @ DOBBS FERRY
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522
Practice Address - Country:US
Practice Address - Phone:914-693-5025
Practice Address - Fax:914-693-6351
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6022808712086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO02423476Medicaid
MO02423476Medicaid
E35974Medicare UPIN