Healthcare Provider Details

I. General information

NPI: 1235140542
Provider Name (Legal Business Name): RICHARD GARY CONWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E 3RD ST
BROOKLYN NY
11230-5572
US

IV. Provider business mailing address

1445 E 3RD ST
BROOKLYN NY
11230-5572
US

V. Phone/Fax

Practice location:
  • Phone: 347-820-0380
  • Fax:
Mailing address:
  • Phone: 347-820-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number123809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: