Provider Demographics
NPI:1689278996
Name:CONCERTO PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:CONCERTO PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER AND 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 STE 100
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 1:8200 FLOURTOWN AVE STE 3
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7969
Practice Address - Country:US
Practice Address - Phone:847-233-1200
Practice Address - Fax:847-443-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment