Provider Demographics
NPI:1962957522
Name:LISOJO-PONEMON, VALERIE (RDCS)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:LISOJO-PONEMON
Suffix:
Gender:F
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 COLLFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4257
Mailing Address - Country:US
Mailing Address - Phone:718-285-4181
Mailing Address - Fax:
Practice Address - Street 1:694 COLLFIELD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4257
Practice Address - Country:US
Practice Address - Phone:718-285-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
115083246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography