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General NPI Number Information
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NPI Number | 1609224153
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Entity Type | Organization
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Legal Business Name | CORVITALS, INC.
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 590 NICHOLS ROAD SUITE 1
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City | DEER PARK
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State | NY
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Zip | 11729
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Country | US
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Telephone | 888-401-9998
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Fax | 800-559-3413
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Provider Business Mailing Address
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Address Line | P.O. BOX 270
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City | MALVERNE
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State | NY
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Zip | 11565
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Country | US
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Telephone | 888-401-9998
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Fax | 800-559-3413
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Authorized Official
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Title or Position | CFO
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Name | MR. JOHN W BOTH
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Credential |
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Telephone | 888-401-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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