Provider Demographics
NPI:1679311393
Name:JODI CONLAN NURSE PRACTITIONER IN GERONTOLOGY PLLC
Entity type:Organization
Organization Name:JODI CONLAN NURSE PRACTITIONER IN GERONTOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:518-461-1374
Mailing Address - Street 1:4780 DUANESBURG RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DUANESBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12056-3422
Mailing Address - Country:US
Mailing Address - Phone:518-299-5007
Mailing Address - Fax:518-510-9783
Practice Address - Street 1:4780 DUANESBURG RD STE 102
Practice Address - Street 2:
Practice Address - City:DUANESBURG
Practice Address - State:NY
Practice Address - Zip Code:12056-3422
Practice Address - Country:US
Practice Address - Phone:518-461-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty