Healthcare Provider Details

I. General information

NPI: 1861134868
Provider Name (Legal Business Name): LINNEA CONGDON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BIRDSALL ST
GREENE NY
13778-1057
US

IV. Provider business mailing address

33 LEWIS RD 2ND FL
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-656-4115
  • Fax: 607-656-9553
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349948
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: