Provider Demographics
NPI:1063659779
Name:CONGDON, JENNIFER ERIN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:CONGDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 MADISON MARKETPLACE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-2343
Mailing Address - Country:US
Mailing Address - Phone:315-825-3111
Mailing Address - Fax:
Practice Address - Street 1:55 CALVARY DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1032
Practice Address - Country:US
Practice Address - Phone:315-363-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine