Healthcare Provider Details

I. General information

NPI: 1104627728
Provider Name (Legal Business Name): KONRAD FONDRIE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3474
US

IV. Provider business mailing address

601 HUDSON AVE
ALBANY NY
12203-1503
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6000
  • Fax:
Mailing address:
  • Phone: 608-515-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number844951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: