Basic Information
| Provider Information | |||||||||
| NPI: | 1295312759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NUVANCE HEALTH MEDICAL PRACTICE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759661 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 ROUTE 52 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105121200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457902500 | ||||||||
| FaxNumber: | 8457902300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2021 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | WASKIEL | ||||||||
| AuthorizedOfficialFirstName: | JAYMA | ||||||||
| AuthorizedOfficialMiddleName: | NOLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PAYER RELATIONS & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 2037397534 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.