Provider Demographics
NPI:1427592203
Name:CONLEY, JAN (MANYS CERTTSHH)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MANYS CERTTSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OLD STATE ROAD
Mailing Address - Street 2:APT 93
Mailing Address - City:HIGHLAND FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10928-4407
Mailing Address - Country:US
Mailing Address - Phone:914-930-9528
Mailing Address - Fax:845-446-7198
Practice Address - Street 1:OLD STATE ROAD
Practice Address - Street 2:APT 93
Practice Address - City:HIGHLAND FALLS
Practice Address - State:NY
Practice Address - Zip Code:10928
Practice Address - Country:US
Practice Address - Phone:914-930-9528
Practice Address - Fax:845-446-7198
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist