1063716132 NPI number — ADVANCED CARDIOVASCULAR CARE OF HUDSON VALLEY

Table of content: (NPI 1063716132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063716132 NPI number — ADVANCED CARDIOVASCULAR CARE OF HUDSON VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR CARE OF HUDSON VALLEY
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:
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:
1063716132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 ROUTE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY COTTAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10989-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-268-0880
Provider Business Mailing Address Fax Number:
845-268-0882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 LIVINGSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHVALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07647-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-710-5955
Provider Business Practice Location Address Fax Number:
201-710-5955
Provider Enumeration Date:
01/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTHREN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-268-0880

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  25MA05521000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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