Healthcare Provider Details

I. General information

NPI: 1508834540
Provider Name (Legal Business Name): NICHOLAS KONDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CARE LANE
SARATOGA SPRINGS NY
12866
US

IV. Provider business mailing address

6 CARE LN
SARATOGA SPRINGS NY
12866-8624
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-7625
  • Fax: 518-587-0273
Mailing address:
  • Phone: 800-243-5854
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number206317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: