Provider Demographics
NPI:1811745375
Name:IMC VARICOSE VEINS PA
Entity type:Organization
Organization Name:IMC VARICOSE VEINS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-294-0819
Mailing Address - Street 1:259 S MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 HUDSON ST STE 3-4
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6638
Practice Address - Country:US
Practice Address - Phone:845-379-9000
Practice Address - Fax:845-933-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty