Healthcare Provider Details

I. General information

NPI: 1821740622
Provider Name (Legal Business Name): CONCIERGE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 BRICK BLVD STE 110
BRICK NJ
08723-6031
US

IV. Provider business mailing address

317 BRICK BLVD STE 110
BRICK NJ
08723-6031
US

V. Phone/Fax

Practice location:
  • Phone: 848-333-0435
  • Fax:
Mailing address:
  • Phone: 848-333-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ARYAY GEFEN
Title or Position: OWNER
Credential: APN
Phone: 848-333-0435