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General NPI Number Information
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NPI Number | 1083643597
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Entity Type | Individual
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Provider Name | MARY T KONDOLEON MD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 32 CLINTON ST
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City | PATERSON
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State | NJ
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Zip | 07522-1775
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Country | US
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Telephone | 973-790-6594
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Fax |
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Provider Business Mailing Address
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Address Line | 82 IRONIA RD
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City | MENDHAM
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State | NJ
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Zip | 07945-3129
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Country | US
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Telephone | 201-704-0675
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA06672300
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License Number State | NJ
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