Provider Demographics
NPI:1053506261
Name:FREDRIC M KARDON MD PC
Entity Type:Organization
Organization Name:FREDRIC M KARDON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-734-9539
Mailing Address - Street 1:108 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1318
Mailing Address - Country:US
Mailing Address - Phone:607-734-9539
Mailing Address - Fax:607-734-6293
Practice Address - Street 1:108 E 14TH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA HTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1318
Practice Address - Country:US
Practice Address - Phone:607-734-9539
Practice Address - Fax:607-734-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38325AMedicare PIN
NYB81951Medicare UPIN