MEDICARE: RICHARD LESLIE COVEN MD

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	207R00000X	Internal Medicine Physician	136115	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16A911	OTHER		EMPIRE MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750383261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LESLIE COVEN MD

Provider Business Mailing Address
First Line	:	56 GRAND CENTRAL AVE
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-3749
Country	:	US
Telephone Number	:	631-264-2788
Fax Number	:	631-264-2787

Provider Business Practice Location Address
First Line	:	56 GRAND CENTRAL AVE
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-3749
Country	:	US
Telephone Number	:	631-264-2788
Fax Number	:	631-264-2787

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/20/2009

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