1043550742 NPI number — NUVANCE HEALTH MEDICAL PRACTICE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043550742 NPI number — NUVANCE HEALTH MEDICAL PRACTICE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUVANCE HEALTH MEDICAL PRACTICE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043550742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 ROUTE 55
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LAGRANGEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-475-9661
Provider Business Mailing Address Fax Number:
845-475-9938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 ROUTE 44
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-677-8358
Provider Business Practice Location Address Fax Number:
845-677-6205
Provider Enumeration Date:
02/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DARCY
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
203-739-4593

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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