Healthcare Provider Details

I. General information

NPI: 1972474732
Provider Name (Legal Business Name): KYLE SKOVIRA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 7TH AVE STE 1106
NEW YORK NY
10019-0029
US

IV. Provider business mailing address

222 HENRIETTA ST
ROCHESTER NY
14620-1512
US

V. Phone/Fax

Practice location:
  • Phone: 646-797-4340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128859-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: