MEDICARE: DR. STEPHEN ALAN KOWALSKY OD

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	152W00000X	Optometrist	27OA00390300	NJ

General Provider Information

NPI Number	:	1700880341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ALAN KOWALSKY OD

Provider Business Mailing Address
First Line	:	21 LAFAYETTE RD
Second Line	:	SUITE C
City	:	SPARTA
State	:	NJ
Zip	:	07871-3575
Country	:	US
Telephone Number	:	973-729-7755
Fax Number	:	973-729-0677

Provider Business Practice Location Address
First Line	:	21 LAFAYETTE RD
Second Line	:	SUITE C
City	:	SPARTA
State	:	NJ
Zip	:	07871-3575
Country	:	US
Telephone Number	:	973-729-7755
Fax Number	:	973-729-0677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/07/2011

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