Healthcare Provider Details

I. General information

NPI: 1003587619
Provider Name (Legal Business Name): KOND MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPPER ST
UTICA NY
13501-3508
US

IV. Provider business mailing address

1 HOPPER ST
UTICA NY
13501-3508
US

V. Phone/Fax

Practice location:
  • Phone: 315-864-8587
  • Fax:
Mailing address:
  • Phone: 315-864-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NERINA J MOULTRIEZ
Title or Position: CEO
Credential:
Phone: 315-717-2126