Provider Demographics
NPI:1689432197
Name:CONCEPCION, RIA (LAC)
Entity Type:Individual
Prefix:
First Name:RIA
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 48TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1239
Mailing Address - Country:US
Mailing Address - Phone:646-515-7536
Mailing Address - Fax:
Practice Address - Street 1:118 W 72ND ST REAR LOBBY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3316
Practice Address - Country:US
Practice Address - Phone:646-767-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty