Individual
DR. GERALYN MICHELE PONZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
127 PINE ST, MONTCLAIR, NJ 07042-4855
(973) 783-0073
(973) 783-4010
Mailing address
127 PINE ST, MONTCLAIR, NJ 07042-4855
(973) 783-0073
(973) 783-4010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA07671800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0049883
—
NJ
Enumeration date
11/18/2005
Last updated
12/11/2009
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