Provider Demographics
NPI:1114796166
Name:CONDON, RICHARD (LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CONDON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 ROUTE 44 55
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5123
Mailing Address - Country:US
Mailing Address - Phone:845-750-8426
Mailing Address - Fax:
Practice Address - Street 1:2731 ROUTE 44 55
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:NY
Practice Address - Zip Code:12525-5123
Practice Address - Country:US
Practice Address - Phone:845-255-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005566172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist