Healthcare Provider Details

I. General information

NPI: 1417865031
Provider Name (Legal Business Name): CARLOS J COWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CENTRAL AVE
ALBANY NY
12205-5069
US

IV. Provider business mailing address

418 BROADWAY STE R
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 518-366-7080
  • Fax:
Mailing address:
  • Phone: 518-366-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: