Healthcare Provider Details

I. General information

NPI: 1750637922
Provider Name (Legal Business Name): KEVIN GERARD BOWLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GEORGIA AVE
LONG BEACH NY
11561-1231
US

IV. Provider business mailing address

5 GEORGIA AVE
LONG BEACH NY
11561-1231
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-4466
  • Fax:
Mailing address:
  • Phone: 516-705-4466
  • Fax: 516-705-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number564584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: