Provider Demographics
NPI:1871998450
Name:DA CONCEICAO JUNIOR, VITOR
Entity type:Individual
Prefix:
First Name:VITOR
Middle Name:
Last Name:DA CONCEICAO JUNIOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 60TH ST
Mailing Address - Street 2:AP 24F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E 60TH ST
Practice Address - Street 2:AP 24F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1514
Practice Address - Country:US
Practice Address - Phone:917-334-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP932272086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology