Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 198183 | NY |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 198183 | NY |
NPI | 1053349605 |
---|---|
Provider Name | Stephen Kovacs |
First Address | Lagrangeville, NY 12540-5108 |
Second Address | Poughkeepsie, NY 12601-3947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 29/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01543411 | (05) | NY |