MEDICARE: JAROSLAW S PONDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	25MA07479000	NJ
2	207R00000X	Internal Medicine Physician	25MA07479000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487665717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAROSLAW S PONDO MD

Provider Business Mailing Address
First Line	:	71 UNION AVE
Second Line	:	SUITE 107
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1274
Country	:	US
Telephone Number	:	201-896-0050
Fax Number	:	201-896-0051

Provider Business Practice Location Address
First Line	:	71 UNION AVE
Second Line	:	SUITE 107
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1274
Country	:	US
Telephone Number	:	201-896-0050
Fax Number	:	201-896-0051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	06/11/2013

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