Provider Demographics
NPI:1164483954
Name:CONDRO, NANCYANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:NANCYANN
Middle Name:
Last Name:CONDRO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-794-7741
Mailing Address - Fax:845-794-0228
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-794-7741
Practice Address - Fax:845-794-0228
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004638213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01157304Medicaid
NY044109001OtherMEDICARE DMERC
NYP50281Medicare PIN
NY01157304Medicaid