Individual
DOMINIC CONCEPCION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
377 THOMAS AVE, LYNDHURST, NJ 07071-3146
(718) 710-1981
Mailing address
377 THOMAS AVE, LYNDHURST, NJ 07071-3146
(718) 710-1981
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT01348000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18KT01348000
NJ STATE LICENSE
NJ
Enumeration date
08/27/2019
Last updated
08/27/2019
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