Provider Demographics
NPI:1992879498
Name:KONDRAT, DONALD E (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
Last Name:KONDRAT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 LAKE WALLKILL RD
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4609
Mailing Address - Country:US
Mailing Address - Phone:973-875-1036
Mailing Address - Fax:
Practice Address - Street 1:86 MARKET ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2404
Practice Address - Country:US
Practice Address - Phone:973-777-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009772011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2084902Medicaid