Provider Demographics
NPI:1942363437
Name:PONCE CONTRERAS, MARTA REGINA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:REGINA
Last Name:PONCE CONTRERAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COLUMN CT
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2002
Mailing Address - Country:US
Mailing Address - Phone:201-818-2034
Mailing Address - Fax:973-472-4835
Practice Address - Street 1:1060 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2591
Practice Address - Country:US
Practice Address - Phone:201-489-0096
Practice Address - Fax:201-488-2930
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08184500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7223970OtherAETNA
NJ387749500OtherAMERIHEALTH
NJ454509813OtherMAGNACARE
NJ7044084OtherCIGNA
NJP4464080OtherOXFORD
NJ11774599OtherANTHEM
NJ454509813OtherUNITED HEALTHCARE
NJ7223970OtherAETNA