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General NPI Number Information
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NPI Number | 1487759445
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Entity Type | Organization
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Legal Business Name | JAMES D KONDRUP M.D, PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 200 PLAZA DR SUITE A
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City | VESTAL
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State | NY
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Zip | 13850-3680
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Country | US
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Telephone | 607-797-7070
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Fax | 607-797-9048
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Provider Business Mailing Address
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Address Line | 200 PLAZA DR SUITE A
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City | VESTAL
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State | NY
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Zip | 13850-3680
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Country | US
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Telephone | 607-797-7070
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Fax | 607-797-9048
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JAMES DANA KONDRUP
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Credential | M.D
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Telephone | 607-797-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1774463
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License Number State | NY
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