Provider Demographics
NPI:1124035217
Name:NORTHERN VALLEY VASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN VALLEY VASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:NALBANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-254-6882
Mailing Address - Street 1:48 BI STATE PLZ # 225
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7003
Mailing Address - Country:US
Mailing Address - Phone:212-254-6882
Mailing Address - Fax:212-254-6886
Practice Address - Street 1:48 BI STATE PLZ # 225
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7003
Practice Address - Country:US
Practice Address - Phone:212-254-6882
Practice Address - Fax:212-254-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2106512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWJW0810Medicare PIN
NYH36492Medicare UPIN