Provider Demographics
NPI:1720021025
Name:CONLON, MICHAEL JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:CONLON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 23RD ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2427
Mailing Address - Country:US
Mailing Address - Phone:212-486-8573
Mailing Address - Fax:212-486-8498
Practice Address - Street 1:119 W 23RD ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2427
Practice Address - Country:US
Practice Address - Phone:212-486-8573
Practice Address - Fax:212-486-8498
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018121-12081S0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14X21Medicare ID - Type Unspecified