Provider Demographics
NPI:1932344215
Name:CONDE, JANE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ALEXANDRA
Last Name:CONDE
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 1:22 WEST LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1907
Mailing Address - Country:US
Mailing Address - Phone:914-533-3024
Mailing Address - Fax:
Practice Address - Street 1:101 11TH AVE S STE 155
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3946
Practice Address - Country:US
Practice Address - Phone:208-466-1077
Practice Address - Fax:208-467-2201
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005320-1171W00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor