Provider Demographics
NPI:1740247840
Name:SIA, CONCEPCION (MD)
Entity type:Individual
Prefix:DR
First Name:CONCEPCION
Middle Name:
Last Name:SIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COMMUNITY DR
Mailing Address - Street 2:NSUH-DEPT OF PEDIATRICS
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3816
Mailing Address - Country:US
Mailing Address - Phone:516-562-4665
Mailing Address - Fax:516-562-4516
Practice Address - Street 1:972 BRUSH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1740
Practice Address - Country:US
Practice Address - Phone:516-876-5555
Practice Address - Fax:516-876-5539
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1154392080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00584170Medicaid
B12995Medicare UPIN
NY06517Medicare ID - Type Unspecified
NY00584170Medicaid