Healthcare Provider Details

I. General information

NPI: 1215943121
Provider Name (Legal Business Name): TODD R. COVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E PULASKI RD
HUNTINGTON STATION NY
11746-1915
US

IV. Provider business mailing address

180 E PULASKI RD
HUNTINGTON STATION NY
11746-1915
US

V. Phone/Fax

Practice location:
  • Phone: 631-425-2121
  • Fax:
Mailing address:
  • Phone: 631-425-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME91883
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number200749-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: