Healthcare Provider Details

I. General information

NPI: 1215836754
Provider Name (Legal Business Name): IRYNA KOVBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 RONALD REAGAN BLVD
WARWICK NY
10990-4105
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5012
US

V. Phone/Fax

Practice location:
  • Phone: 845-328-8967
  • Fax:
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: