Healthcare Provider Details

I. General information

NPI: 1891609558
Provider Name (Legal Business Name): CONCIERGE MEDICINE OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 MIDDLE COUNTRY ROAD SUITE 1
LAKE GROVE NY
11507
US

IV. Provider business mailing address

1188 WILLIS AVE # 227
ALBERTSON NY
11507-1229
US

V. Phone/Fax

Practice location:
  • Phone: 631-247-7463
  • Fax: 631-532-4911
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SATHISH J SUBBAIAH
Title or Position: PRESIDENT
Credential: MD
Phone: 631-372-5771