Healthcare Provider Details

I. General information

NPI: 1457438988
Provider Name (Legal Business Name): MICHAEL CONLON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 59TH ST
NEW YORK NY
10022-1537
US

IV. Provider business mailing address

330 E 59TH ST
NEW YORK NY
10022-1537
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 TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number018121-1
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL J CONLON
Title or Position: P.T.
Credential:
Phone: 212-486-8573