Provider Demographics
NPI:1972520765
Name:PONZIO ORTHOPEDICS
Entity Type:Organization
Organization Name:PONZIO ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PONZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-582-7979
Mailing Address - Street 1:449 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9369
Mailing Address - Country:US
Mailing Address - Phone:856-582-7979
Mailing Address - Fax:856-582-4259
Practice Address - Street 1:449 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9369
Practice Address - Country:US
Practice Address - Phone:856-582-7979
Practice Address - Fax:856-582-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52501207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058899Medicare ID - Type UnspecifiedGROUP ID