Basic Information
| Provider Information | |||||||||
| NPI: | 1437273380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MVH MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2149 | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068132149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037756659 | ||||||||
| FaxNumber: | 2037756692 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 N 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | MT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105502026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146648000 | ||||||||
| FaxNumber: | 9146687233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2007 | ||||||||
| LastUpdateDate: | 09/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | ALAIE | ||||||||
| AuthorizedOfficialFirstName: | DARIUSH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9146683806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01149339 | 05 | NY | MEDICAID |