Healthcare Provider Details

I. General information

NPI: 1417112459
Provider Name (Legal Business Name): JAROSLAW S. PONDO, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 UNION AVE SUITE 107
RUTHERFORD NJ
07070-1274
US

IV. Provider business mailing address

146 MORTIMER AVE
RUTHERFORD NJ
07070-1615
US

V. Phone/Fax

Practice location:
  • Phone: 201-896-0050
  • Fax: 201-896-0051
Mailing address:
  • Phone: 201-935-2087
  • Fax: 201-935-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07479000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA07479000
License Number StateNJ

VIII. Authorized Official

Name: JAROSLAW S PONDO
Title or Position: OWNER
Credential: M.D.
Phone: 201-896-0050