Provider Demographics
NPI:1528174091
Name:PONTIUS, ALLISON TERESA (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:TERESA
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:59 E 79TH ST
Mailing Address - Street 2:SUITE 1AB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0258
Mailing Address - Country:US
Mailing Address - Phone:212-288-0450
Mailing Address - Fax:212-288-4208
Practice Address - Street 1:59 E 79TH ST
Practice Address - Street 2:SUITE 1AB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0258
Practice Address - Country:US
Practice Address - Phone:212-288-0450
Practice Address - Fax:212-288-4208
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY231323207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI09895Medicare UPIN