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General NPI Number Information
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NPI Number | 1831836162
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Entity Type | Organization
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Legal Business Name | CONCIERGE SPINE AND SPORTS MEDICINE, PC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 1200 CONSTITUTION AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19112-1329
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Country | US
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Telephone | 267-551-4200
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Fax | 856-861-0928
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Provider Business Mailing Address
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Address Line | 22 MADEIRA CT
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3144
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Country | US
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Telephone | 202-262-5629
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Fax | 856-861-0928
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. MALINI M KHANNA
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Credential | MD
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Telephone | 267-551-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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