Provider Demographics
NPI: | 1134469836 |
---|---|
Name: | NUVANCE HEALTH MEDICAL PRACTICE, PC |
Entity Type: | Organization |
Organization Name: | NUVANCE HEALTH MEDICAL PRACTICE, PC |
Other - Org Name: | NHMP HYDE PARK PC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | VP FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KAREN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DARCY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 203-739-4593 |
Mailing Address - Street 1: | 1351 ROUTE 55 SUITE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAGRANGEVILLE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12540-5108 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-475-9661 |
Mailing Address - Fax: | 845-475-9938 |
Practice Address - Street 1: | 4068 ALBANY POST RD |
Practice Address - Street 2: | |
Practice Address - City: | HYDE PARK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12538-3900 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-229-2123 |
Practice Address - Fax: | 845-229-6313 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-02-18 |
Last Update Date: | 2021-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty |