Individual
MS. MICHELLE PONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
202 FOSTER AVE, BROOKLYN, NY 11230-2119
(718) 853-1750
Mailing address
85 MARY ST APT D, LODI, NJ 07644-2864
(718) 590-0673
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
789828
NY
Other
Enumeration date
12/19/2013
Last updated
12/19/2013
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