Provider Demographics
NPI:1194796714
Name:CONCEPCION, JOSE Q (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:Q
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BARLOW DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-763-1042
Mailing Address - Fax:
Practice Address - Street 1:1620 E NEW YORK AVE
Practice Address - Street 2:HOWARD HOUSES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6861
Practice Address - Country:US
Practice Address - Phone:718-385-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00643370Medicaid