=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083783559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY CARDIOVASCULAR ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 CRYSTAL RUN ROAD ORANGE REGIONAL MEDICAL PAVILION SUITE 100
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-703-3000
-----------------------------------------------------
Fax | 845-703-3003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 CRYSTAL RUN ROAD ORANGE REGIONAL MEDICAL PAVILION SUITE 100
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-703-3000
-----------------------------------------------------
Fax | 845-703-3003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CARDIOLOGIST
-----------------------------------------------------
Name | DR. ANDREW MILTON GOLDMANN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-703-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MA45975
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 1312971
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------