Provider Demographics
NPI:1487916268
Name:CONCEPCION, ARDELY J (SPECIAL EDUCATOR)
Entity type:Individual
Prefix:
First Name:ARDELY
Middle Name:J
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2720
Mailing Address - Country:US
Mailing Address - Phone:917-648-0532
Mailing Address - Fax:
Practice Address - Street 1:349 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2720
Practice Address - Country:US
Practice Address - Phone:917-648-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor