Provider Demographics
NPI:1558934398
Name:CONCERTO DELAWARE LLC
Entity Type:Organization
Organization Name:CONCERTO DELAWARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER & MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-443-1228
Mailing Address - Street 1:4600 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1606
Mailing Address - Country:US
Mailing Address - Phone:847-443-1228
Mailing Address - Fax:847-443-1328
Practice Address - Street 1:15 OMEGA DRIVE
Practice Address - Street 2:BUILDING K, SUITE #5
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2057
Practice Address - Country:US
Practice Address - Phone:847-443-1228
Practice Address - Fax:847-443-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment