Healthcare Provider Details

I. General information

NPI: 1023464138
Provider Name (Legal Business Name): RORY V CONDON MSN, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION ST
DERBY CT
06418-1326
US

IV. Provider business mailing address

66 CHESTNUT ST
BRANFORD CT
06405-3749
US

V. Phone/Fax

Practice location:
  • Phone: 203-887-0604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number112100
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6636
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: