1083783559 NPI number — VALLEY CARDIOVASCULAR ASSOCIATES, P.C.

Table of content: (NPI 1083783559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083783559 NPI number — VALLEY CARDIOVASCULAR ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CARDIOVASCULAR ASSOCIATES, P.C.
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:
1083783559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 CRYSTAL RUN ROAD
Provider Second Line Business Mailing Address:
ORANGE REGIONAL MEDICAL PAVILION SUITE 100
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-703-3000
Provider Business Mailing Address Fax Number:
845-703-3003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 CRYSTAL RUN ROAD
Provider Second Line Business Practice Location Address:
ORANGE REGIONAL MEDICAL PAVILION SUITE 100
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-703-3000
Provider Business Practice Location Address Fax Number:
845-703-3003
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMANN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
MILTON
Authorized Official Title or Position:
CARDIOLOGIST
Authorized Official Telephone Number:
845-703-3000

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MA45975 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 1312971 , 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)

  • Identifier: 00827078 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 958492 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0035104 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111457 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 559415 . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P471437 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0034324 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".




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