Provider Demographics
NPI:1295487593
Name:CONCIERGE RADIOLOGY GROUP LLC
Entity type:Organization
Organization Name:CONCIERGE RADIOLOGY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-509-3755
Mailing Address - Street 1:520 WEST AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6797
Mailing Address - Country:US
Mailing Address - Phone:516-509-3755
Mailing Address - Fax:
Practice Address - Street 1:520 WEST AVE APT 705
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6797
Practice Address - Country:US
Practice Address - Phone:516-509-3755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty