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General NPI Number Information
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NPI Number | 1730133950
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Entity Type | Organization
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Legal Business Name | STEPHEN A. KOWALSKY, O.D.
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 21 LAFAYETTE RD SUITE C
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City | SPARTA
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State | NJ
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Zip | 07871-3575
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Country | US
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Telephone | 973-729-7755
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Fax | 973-729-0677
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Provider Business Mailing Address
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Address Line | 21 LAFAYETTE RD SUITE C
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City | SPARTA
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State | NJ
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Zip | 07871-3575
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Country | US
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Telephone | 973-729-7755
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Fax | 973-729-0677
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN ALAN KOWALSKY
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Credential | O.D.
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Telephone | 973-729-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00390300
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License Number State | NJ
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