Provider Demographics
NPI:1063781698
Name:GWEN S. KOROVIN, M.D. P.C.
Entity type:Organization
Organization Name:GWEN S. KOROVIN, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOROVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-6630
Mailing Address - Street 1:70 E 77TH ST
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1811
Mailing Address - Country:US
Mailing Address - Phone:212-879-6630
Mailing Address - Fax:212-650-9736
Practice Address - Street 1:70 E 77TH ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1811
Practice Address - Country:US
Practice Address - Phone:212-879-6630
Practice Address - Fax:212-650-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163850261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62369Medicare UPIN