MEDICARE: KOVAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1043517212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOVAL INC

Provider Business Mailing Address
First Line	:	227 HOLLAND RD
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 KENNEDY BLVD W
Second Line	:	SUITE 108
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1256
Country	:	US
Telephone Number	:	917-656-6757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. IGOR KOVAL
Credential	:
Telephone Number	:	917-656-6757

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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