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General NPI Number Information
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NPI Number | 1477571826
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL PRACTICE II
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 PROSPECT ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-689-1933
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Fax | 201-689-1935
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Provider Business Mailing Address
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Address Line | 106 PROSPECT ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-689-1933
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Fax | 201-689-1935
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARJORIE MARIE CONDON
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Credential | DO
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Telephone | 201-689-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB54119
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License Number State | NJ
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