MEDICARE: AVNER KONDOV FNP

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	163W00000X	Registered Nurse	854453	NY
2	363LF0000X	Family Nurse Practitioner	359827	NY

General Provider Information

NPI Number	:	1861339988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVNER KONDOV FNP

Provider Business Mailing Address
First Line	:	6836 108TH ST APT A13
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6836 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-8907
Country	:	US
Telephone Number	:	917-826-8022
Fax Number	:

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

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	05/29/2026

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