MEDICARE: CONCERTOCARE MEDICAL OF NEW JERSEY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1265208771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCERTOCARE MEDICAL OF NEW JERSEY, PC

Provider Business Mailing Address
First Line	:	PO BOX 801280
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1280
Country	:	US
Telephone Number	:	877-597-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 VINE ST STE 221
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5250
Country	:	US
Telephone Number	:	877-597-1440
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HISHAM YOUSIF
Credential	:	MD
Telephone Number	:	480-227-9166

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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