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General NPI Number Information
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NPI Number | 1962698662
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Entity Type | Organization
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Legal Business Name | PETER CONDAX MD PC
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 170-17 NORTHERN BLVD.
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 718-539-6000
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Fax | 718-539-4021
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Provider Business Mailing Address
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Address Line | 170-17 NORTHERN BLVD.
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 718-539-6000
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Fax | 718-539-4021
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER CONDAX
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Credential | M.D.
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Telephone | 718-539-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 204160
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License Number State | NY
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