Provider Demographics
NPI:1629338652
Name:GONDEK, MARCI
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:GONDEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 E SENECA TPKE
Mailing Address - Street 2:APT A24
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:681 E SENECA TPKE
Practice Address - Street 2:APT A24
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2616
Practice Address - Country:US
Practice Address - Phone:315-778-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator