Provider Demographics
NPI:1326561515
Name:CONDOR, ELISE PHOEBE (RN-BSN, NP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:PHOEBE
Last Name:CONDOR
Suffix:
Gender:F
Credentials:RN-BSN, NP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:HOUSE
Other - Last Name:KOGUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-BSN, NP
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:
Practice Address - Street 1:490 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-402176-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health