Individual
DR. JONATHAN D. PONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3915 BROADWAY, NEW YORK, NY 10032-1565
(212) 567-5536
(212) 202-6447
Mailing address
3915 BROADWAY, NEW YORK, NY 10032-1565
(212) 567-5536
(212) 202-6447
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
056400-1
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
P51889
NY
Other
Enumeration date
07/02/2009
Last updated
12/17/2013
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