NPIMap

Individual provider Active NPI

Dominick Condo, M.D.

  • Internal Medicine Physician
  • Bayonne, NJ
National Provider Identifier
1114019692
Registry record updated Dec 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA041384 Issued in NJ
Practice address
622 Broadway
Bayonne, NJ 07002-3821
Phone
(201) 436-2800
Fax
(201) 436-9840
NPI assigned
Sep 29, 2006
Last updated
Dec 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA041384 NJ Primary

Addresses

Primary practice location

622 Broadway
Bayonne, NJ 07002-3821

Mailing address

622 Broadway
Bayonne, NJ 07002-3821
Phone (201) 436-2800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060112000107 NJ Practitioner - Internal Medicine 8224922208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dominick Condo, MD PAGroup PAC ID 5890689871, 4 clinicians

Practice addresses (Care Compare)

622 Broadway
Bayonne, NJ 07002-3821
Phone (201) 436-2800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA041384NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ijkg Opco LLC Current Accepting new patients
Dominick Condo, MD PA Internal Medicine CurrentSince Jan 1, 1986 Accepting new patients
Dominick Condo MD PA Past Accepting new patients

Locations

622 Broadway
Bayonne, NJ 07002
Phone (201) 436-2800

Interoperability endpoints

  • Direct secure messaging: dcondo@bayonnemd.gwaydirect.com
  • Direct secure messaging: dominick.condo@direct.bayonnemedicalcenter.md

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1114019692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023821",
            "telephone_number": "201-436-2800",
            "fax_number": "201-436-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023821",
            "telephone_number": "201-436-2800",
            "fax_number": "201-436-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDO",
        "first_name": "DOMINICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA041384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayonne, NJ

Sources for this page

Verify at the official NPI Registry.