Physician Compare National (NPI:1780079020)

HEALTHCARE PROVIDER: ANGELA CONDO MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1780079020
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688928492
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190306001183
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CONDO
	Individual professional last name
Provider First Name	ANGELA
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	RUTGERS R W JOHNSON MEDICAL SCHOOL (CAM/NEW BRUNS/PISC)
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	DOMINICK CONDO, MD PA
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	5890689871
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	622 BROADWAY
	Group Practice or individual's line 1 address
City	BAYONNE
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	070023821
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2014362800
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330169
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MOUNT SINAI BETH ISRAEL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y