Healthcare Provider Details

I. General information

NPI: 1912837097
Provider Name (Legal Business Name): JENNY CONDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 S 23RD ST
KENILWORTH NJ
07033-1630
US

IV. Provider business mailing address

56 S 23RD ST
KENILWORTH NJ
07033-1630
US

V. Phone/Fax

Practice location:
  • Phone: 908-410-1033
  • Fax: 908-410-1033
Mailing address:
  • Phone: 908-410-1033
  • Fax: 908-410-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: