Provider Demographics
NPI:1952119802
Name:ND CONCIERGE MEDICINE
Entity type:Organization
Organization Name:ND CONCIERGE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NONKULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DLADLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:917-951-0792
Mailing Address - Street 1:120 STONEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1635
Mailing Address - Country:US
Mailing Address - Phone:347-277-8324
Mailing Address - Fax:
Practice Address - Street 1:120 STONEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1635
Practice Address - Country:US
Practice Address - Phone:347-277-8324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty