Provider Demographics
NPI:1700153608
Name:CONDO, MARGARET B (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:B
Last Name:CONDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-3900
Mailing Address - Country:US
Mailing Address - Phone:518-207-2680
Mailing Address - Fax:518-477-4466
Practice Address - Street 1:29 ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-3900
Practice Address - Country:US
Practice Address - Phone:518-207-2680
Practice Address - Fax:518-477-4466
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409145Medicaid