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Michael Conrad

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NPI Number Detailed Information

Provider Information:

Name: Michael Conrad
Gender: M
Provider License Number If Given: 164820

NPI Information:

NPI: 1003800533
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 8012 3RD AVE
Brooklyn, NY 11209
Phone Number: 7187455600
Fax Number:

Provider Business Practice Location Address:

Address: 8012 3RD AVE
Brooklyn, NY 11209
Phone Number: 7187455600
Fax Number:

Provider Taxonomy:

Primary: 207Q00000X
Secondary (if any):
State: NY

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