Individual
MARTHA CONCHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4277 65TH PL, WOODSIDE, NY 11377-5054
(718) 429-2000
(718) 334-0057
Mailing address
235 WADSWORTH AVE, 4A, NEW YORK, NY 10033-3810
(646) 584-8268
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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