| Doctor Name: | DR. JEREMY HENRY CONKLIN |
| NPI Number: | 1700830882 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | OS013779 |
| Business Practice Address: | 43 New Scotland Ave Mc-61 Albany, NY - 122083412 |
| Business Phone Number: | 5182624880 |
| Business Fax Number: | |
| Mailing Address: | 26 Victoria Way, ALBANY |
| State: | NY |
| Postal Code: | 122091149 |
| Phone Number: | 5707640102 |
| Fax Number: | 2063382948 |
| NPI Enumeration Date: | 05/21/2006 |
| NPI Last Update Date: | 07/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS013779 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |