Organization
VITAL PA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTO MARTIN CONCEPCION MBA (PRESIDENT)
(917) 517-5733
Entity
Organization
Contact information
Practice address
35-20 LEVERICH STREET, STE 230B, JACKSON HEIGHTS, NY 11372-3973
(917) 517-5733
(718) 343-1157
Mailing address
35-20 LEVERICH STREET, STE 230B, JACKSON HEIGHTS, NY 11372-3973
(917) 517-5733
(718) 343-1157
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
08/22/2006
Last updated
04/10/2009
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