Provider Demographics
NPI:1225058969
Name:CONDON, EDWARD M (MD)
Entity Type:Individual
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First Name:EDWARD
Middle Name:M
Last Name:CONDON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6080 JERICHO TPKE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2850
Mailing Address - Country:US
Mailing Address - Phone:631-462-2200
Mailing Address - Fax:866-852-5985
Practice Address - Street 1:6080 JERICHO TPKE
Practice Address - Street 2:SUITE 314
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2850
Practice Address - Country:US
Practice Address - Phone:631-462-2200
Practice Address - Fax:866-852-5985
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-07-31
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Provider Licenses
StateLicense IDTaxonomies
NY127245207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3444104OtherAETNA/US HEALTHCARE HMO
NY4312729OtherAETNA/US HEALTHCARE
NYP3194859OtherOXFORD HEALTH PLAN
NYEC094S0510OtherEMPIRE BCBS-NY
NY2190581OtherCIGNA
NY230035OtherGHI PPO
NY02215447Medicaid
NY000000080165OtherGHI HMO
NY3C6337OtherHEALTH NET
NY230035OtherGHI PPO
NY354781Medicare PIN
NYB13670Medicare UPIN