Healthcare Provider Details

I. General information

NPI: 1720021025
Provider Name (Legal Business Name): MICHAEL JOSEPH CONLON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 23RD ST SUITE 304
NEW YORK NY
10011-2427
US

IV. Provider business mailing address

119 W 23RD ST SUITE 304
NEW YORK NY
10011-2427
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-8573
  • Fax: 212-486-8498
Mailing address:
  • Phone: 212-486-8573
  • Fax: 212-486-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number018121-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018121-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: