Provider Demographics
NPI:1831836162
Name:CONCIERGE SPINE AND SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:CONCIERGE SPINE AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALINI
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-551-4200
Mailing Address - Street 1:22 MADEIRA CT
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3144
Mailing Address - Country:US
Mailing Address - Phone:202-262-5629
Mailing Address - Fax:856-861-0928
Practice Address - Street 1:1200 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1329
Practice Address - Country:US
Practice Address - Phone:267-551-4200
Practice Address - Fax:856-861-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center