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General NPI Number Information
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NPI Number | 1659741387
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Entity Type | Organization
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Legal Business Name | CONCORDE MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 135 E 37TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-3083
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Country | US
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Telephone | 212-683-8107
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Fax |
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Provider Business Mailing Address
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Address Line | 316 E 30TH ST 2ND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-8366
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Country | US
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Telephone | 212-614-0039
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Fax | 212-253-9631
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Authorized Official
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Title or Position | CEO/MANAGING PARTNER
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Name | DR. PAULA MARCHETTA
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Credential | MD
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Telephone | 212-614-0039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 006186
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License Number State | NY
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