Provider Demographics
NPI:1023022217
Name:CONCORDE MEDICAL GROUP,PLLC
Entity Type:Organization
Organization Name:CONCORDE MEDICAL GROUP,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-614-0039
Mailing Address - Street 1:316 E 30TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8303
Mailing Address - Country:US
Mailing Address - Phone:212-614-0039
Mailing Address - Fax:212-253-9631
Practice Address - Street 1:232 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8202
Practice Address - Country:US
Practice Address - Phone:212-614-0039
Practice Address - Fax:212-253-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWES531Medicare PIN