Healthcare Provider Details

I. General information

NPI: 1609224153
Provider Name (Legal Business Name): CORVITALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 NICHOLS ROAD SUITE 1
DEER PARK NY
11729
US

IV. Provider business mailing address

P.O. BOX 270
MALVERNE NY
11565
US

V. Phone/Fax

Practice location:
  • Phone: 888-401-9998
  • Fax: 800-559-3413
Mailing address:
  • Phone: 888-401-9998
  • Fax: 800-559-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN W BOTH
Title or Position: CFO
Credential:
Phone: 888-401-9998