Healthcare Provider Details

I. General information

NPI: 1891375218
Provider Name (Legal Business Name): DANIEL CONDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N COLLEGE AVE # SLOT100
FAYETTEVILLE AR
72703-1908
US

IV. Provider business mailing address

630 W 168TH ST # P&S3-401
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 479-713-8700
  • Fax: 479-714-8670
Mailing address:
  • Phone: 212-305-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: