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General NPI Number Information
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NPI Number | 1457823908
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Entity Type | Individual
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Provider Name | HERBERT ALLEN CONDREY
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Gender | Male
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 7518 S STATE ST
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City | LOWVILLE
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State | NY
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Zip | 13367-1573
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Country | US
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Telephone | 315-874-4294
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Fax | 315-874-4294
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Provider Business Mailing Address
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Address Line | 7518 S STATE ST
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City | LOWVILLE
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State | NY
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Zip | 13367-1573
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Country | US
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Telephone | 315-874-4294
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 14000024120
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License Number State | NY
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