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General NPI Number Information
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NPI Number | 1598909251
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Entity Type | Individual
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Provider Name | STACY LYNN KOVACS PA
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Gender | Female
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Dates
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Enumeration Date | 04/26/2009
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 170 W 12TH ST ST. VINCENTS HOSPITAL-DEPARTMENT OF RADIOLOGY
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City | NEW YORK
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State | NY
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Zip | 10011-8202
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Country | US
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Telephone | 212-604-8719
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 30TH ST
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City | ASTORIA
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State | NY
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Zip | 11106-3152
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Country | US
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Telephone | 917-684-8794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010904
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License Number State | NY
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