Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 204160 | NY |
N | 207WX0107X | Retina Specialist | 204160 | NY |
NPI | 1033170675 |
---|---|
Provider Name | Dr. Peter Condax |
First Address | Astoria, NY 11102-3142 |
Second Address | Astoria, NY 11102-3142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01976585 | (05) | NY |
G96797 | (02) | NY |