Provider Demographics
NPI:1558896464
Name:CONCIERGE HEALTH AND AESTHETICS
Entity type:Organization
Organization Name:CONCIERGE HEALTH AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-307-3094
Mailing Address - Street 1:2333 WARD DR
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2110
Mailing Address - Country:US
Mailing Address - Phone:866-307-3094
Mailing Address - Fax:866-307-3095
Practice Address - Street 1:200 PERRINE ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:866-307-3094
Practice Address - Fax:866-307-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA041188174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty