Provider Demographics
NPI:1558442467
Name:CONCEPCION, JENNIFER (ANP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:1 PENN PLZ
Mailing Address - Street 2:SUITE 725
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119-0002
Mailing Address - Country:US
Mailing Address - Phone:631-929-0060
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:SUITE 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:631-929-0060
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302444363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS72124Medicare UPIN
NY98V101Medicare ID - Type Unspecified