MEDICARE: DR. HERIBERT G CONRADI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	25MA02614300	NJ

General Provider Information

NPI Number	:	1275707267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERIBERT G CONRADI M.D.

Provider Business Mailing Address
First Line	:	2054 RIVERSIDE AVE APT 5402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4448
Country	:	US
Telephone Number	:	904-389-1174
Fax Number	:

Provider Business Practice Location Address
First Line	:	2054 RIVERSIDE AVE APT 5402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4448
Country	:	US
Telephone Number	:	904-389-1174
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	02/15/2026

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