Healthcare Provider Details

I. General information

NPI: 1063588390
Provider Name (Legal Business Name): CONRADO A TOJINO SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 STONY BROOK CT
NEWBURGH NY
12550-6524
US

IV. Provider business mailing address

600 STONY BROOK CT
NEWBURGH NY
12550-6524
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-1538
  • Fax:
Mailing address:
  • Phone: 845-561-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number108443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: