Basic Information
| Provider Information | |||||||||
| NPI: | 1912942608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONCEPCION | ||||||||
| FirstName: | CLEO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 BROAD AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | RIDGEFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076571697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006240792 | ||||||||
| FaxNumber: | 2019438105 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 NORTHFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070521174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732439729 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA030599 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.