Provider Demographics
NPI:1508174673
Name:CONLON, JILL (PT, MHS, DPT)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:CONLON
Suffix:
Gender:F
Credentials:PT, MHS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 WOODVALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3520
Mailing Address - Country:US
Mailing Address - Phone:718-356-7842
Mailing Address - Fax:
Practice Address - Street 1:73 WOODVALE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3520
Practice Address - Country:US
Practice Address - Phone:718-356-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016064-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics