Basic Information
| Provider Information | |||||||||
| NPI: | 1083377048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NUVANCE HEALTH MEDICAL PRACTICE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 RESERVE RD | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068105267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759661 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 MIDDLEBUSH RD STE 302 | ||||||||
| Address2: | |||||||||
| City: | WAPPINGERS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125904076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457901393 | ||||||||
| FaxNumber: | 8457903104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2021 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | WASKIEL | ||||||||
| AuthorizedOfficialFirstName: | JAYMA | ||||||||
| AuthorizedOfficialMiddleName: | NOLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTING/PAYER RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8454759661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.