Healthcare Provider Details

I. General information

NPI: 1740200021
Provider Name (Legal Business Name): POND R KELEMEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ASHFORD AVE COMMUNITY HOSPITAL @ DOBBS FERRY
DOBBS FERRY NY
10522
US

IV. Provider business mailing address

128 ASHFORD AVE COMMUNITY HOSPITAL @ DOBBS FERRY
DOBBS FERRY NY
10522
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-5025
  • Fax: 914-693-6351
Mailing address:
  • Phone: 914-693-5025
  • Fax: 914-693-6351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number602280871
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02423476
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: