Healthcare Provider Details

I. General information

NPI: 1811745375
Provider Name (Legal Business Name): IMC VARICOSE VEINS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 HUDSON ST STE 3-4
HACKENSACK NJ
07601-6638
US

IV. Provider business mailing address

259 S MIDDLETOWN RD
NANUET NY
10954-3327
US

V. Phone/Fax

Practice location:
  • Phone: 845-379-9000
  • Fax: 845-933-2183
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAWN MCCUE
Title or Position: BILLING MANAGER
Credential:
Phone: 845-294-0819