Provider Demographics
NPI:1144580226
Name:NUVANCE HEALTH MEDICAL PRACTICE, PC
Entity Type:Organization
Organization Name:NUVANCE HEALTH MEDICAL PRACTICE, PC
Other - Org Name:HIGHLAND 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
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9603
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:514 ROUTE 299
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2835
Practice Address - Country:US
Practice Address - Phone:845-691-9200
Practice Address - Fax:845-691-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PTAN WZWVQ1Medicare PIN