Healthcare Provider Details

I. General information

NPI: 1245166289
Provider Name (Legal Business Name): PONOS MEDICAL CARE NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE STE 305
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

100 M ST SE STE 600
WASHINGTON DC
20003-3648
US

V. Phone/Fax

Practice location:
  • Phone: 757-704-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GILBERTO BULTRON
Title or Position: OWNER
Credential: MD
Phone: 757-704-1000