Healthcare Provider Details

I. General information

NPI: 1437493152
Provider Name (Legal Business Name): POMONA FAMILY MEDICAL ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MEDICAL PARK DR STE 100
POMONA NY
10970-3559
US

IV. Provider business mailing address

11 MEDICAL PARK DR STE 100
POMONA NY
10970-3559
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-0510
  • Fax: 845-354-0629
Mailing address:
  • Phone: 845-354-0510
  • Fax: 845-354-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONNA LOKETCH
Title or Position: PHYSICIAN, PARTNER
Credential: D.O
Phone: 914-588-1035