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General NPI Number Information
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NPI Number | 1063716132
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Entity Type | Organization
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Legal Business Name | ADVANCED CARDIOVASCULAR CARE OF HUDSON VALLEY
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 220 LIVINGSTON ST
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City | NORTHVALE
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State | NJ
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Zip | 07647-1738
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Country | US
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Telephone | 201-710-5955
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Fax | 201-710-5955
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Provider Business Mailing Address
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Address Line | 206 ROUTE 303
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-2019
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Country | US
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Telephone | 845-268-0880
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Fax | 845-268-0882
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID B SOUTHREN
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Credential | MD
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Telephone | 845-268-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA05521000
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License Number State | NJ
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