Provider Demographics
NPI:1760567788
Name:OWINY, CONRAD O
Entity Type:Individual
Prefix:MR
First Name:CONRAD
Middle Name:O
Last Name:OWINY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-6807
Mailing Address - Country:US
Mailing Address - Phone:267-670-2119
Mailing Address - Fax:267-670-2119
Practice Address - Street 1:331 N OAK ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-6807
Practice Address - Country:US
Practice Address - Phone:267-670-2119
Practice Address - Fax:678-205-5985
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23154837172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver