Provider Demographics
NPI:1598123176
Name:CONCEPCION, ERCILIO
Entity Type:Individual
Prefix:
First Name:ERCILIO
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 E KINGSBRIDGE RD
Mailing Address - Street 2:APT N-46
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4405
Mailing Address - Country:US
Mailing Address - Phone:347-805-6128
Mailing Address - Fax:
Practice Address - Street 1:261 E KINGSBRIDGE RD
Practice Address - Street 2:APT N-46
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4405
Practice Address - Country:US
Practice Address - Phone:347-805-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi