Healthcare Provider Details

I. General information

NPI: 1952564403
Provider Name (Legal Business Name): CATHERINE M CONCERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 07/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

456 STOCKHOLM ST
RIDGEWOOD NY
11385-1333
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8020
  • Fax: 212-844-6306
Mailing address:
  • Phone: 718-386-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: