Healthcare Provider Details

I. General information

NPI: 1013128958
Provider Name (Legal Business Name): CONCORDE MEDICAL GROUP, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E 37TH ST
NEW YORK NY
10016-3083
US

IV. Provider business mailing address

316 E 30TH ST 2ND FLOOR
NEW YORK NY
10016-8366
US

V. Phone/Fax

Practice location:
  • Phone: 212-683-8105
  • Fax:
Mailing address:
  • Phone: 212-614-0039
  • Fax: 212-253-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number244200
License Number StateNY

VIII. Authorized Official

Name: NADEJE S SYLVESTER
Title or Position: PHYSICIAN
Credential: MD
Phone: 212-614-0039