Healthcare Provider Details

I. General information

NPI: 1023022217
Provider Name (Legal Business Name): CONCORDE MEDICAL GROUP,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E 30TH ST
NEW YORK NY
10016-8202
US

IV. Provider business mailing address

316 E 30TH ST 2ND FLOOR
NEW YORK NY
10016-8303
US

V. Phone/Fax

Practice location:
  • Phone: 212-614-0039
  • Fax: 212-253-9631
Mailing address:
  • Phone: 212-614-0039
  • Fax: 212-253-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAULA MARCHETTA
Title or Position: CEO
Credential: M.D.
Phone: 212-614-0039