Basic Information
| Provider Information | |||||||||
| NPI: | 1144580226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NUVANCE HEALTH MEDICAL PRACTICE, PC | ||||||||
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| OtherOrganizationName: | HIGHLAND PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759603 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 514 ROUTE 299 | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125282835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456919200 | ||||||||
| FaxNumber: | 8456913992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2012 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | DARCY | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2037394593 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.