Provider Demographics
NPI:1811137946
Name:GONDAR, VICTORIA ANN (NP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:GONDAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DANIELS AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1605
Mailing Address - Country:US
Mailing Address - Phone:518-926-9041
Mailing Address - Fax:
Practice Address - Street 1:100 CLIFTON CORPORATE PARKWAY
Practice Address - Street 2:SUITE 135
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-223-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305055363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400003799Medicare PIN