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General NPI Number Information
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NPI Number | 1043455314
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Entity Type | Organization
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Legal Business Name | PONZIO MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 127 PINE ST SUITE 10
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4855
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Country | US
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Telephone | 973-783-0073
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Fax | 973-783-4010
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Provider Business Mailing Address
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Address Line | 127 PINE ST SUITE 10
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4855
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Country | US
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Telephone | 973-783-0073
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Fax | 973-783-4010
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Authorized Official
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Title or Position | OWNER
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Name | GERALYN MICHELLE PONZIO
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Credential | M.D.
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Telephone | 973-783-0073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07671800
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License Number State | NJ
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