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General NPI Number Information
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NPI Number | 1023464138
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Entity Type | Individual
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Provider Name | RORY V CONDON MSN, MA
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Gender | Male
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 130 DIVISION ST
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City | DERBY
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State | CT
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Zip | 06418-1326
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Country | US
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Telephone | 203-887-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 66 CHESTNUT ST
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City | BRANFORD
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State | CT
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Zip | 06405-3749
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 112100
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 6636
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License Number State | CT
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