Healthcare Provider Details

I. General information

NPI: 1114486982
Provider Name (Legal Business Name): NUVANCE HEALTH MEDICAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 ROUTE 299
HIGHLAND NY
12528-2835
US

IV. Provider business mailing address

1351 ROUTE 55 STE 200
LAGRANGEVILLE NY
12540-5128
US

V. Phone/Fax

Practice location:
  • Phone: 845-871-4275
  • Fax: 845-871-4362
Mailing address:
  • Phone: 845-475-9661
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN DARCY
Title or Position: VP FINANCE
Credential:
Phone: 203-739-4593