Basic Information
| Provider Information | |||||||||
| NPI: | 1659741387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCORDE MEDICAL GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 E 30TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100168366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126140039 | ||||||||
| FaxNumber: | 2122539631 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 E 37TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100163083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126838107 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2015 | ||||||||
| LastUpdateDate: | 12/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | MARCHETTA | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2126140039 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONCORDE MEDICAL GROUP PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 006186 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.