Provider Demographics
NPI:1427058056
Name:COVELLI, EDWARD MARIO JR (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARIO
Last Name:COVELLI
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 GLENEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1222
Mailing Address - Country:US
Mailing Address - Phone:845-228-7000
Mailing Address - Fax:
Practice Address - Street 1:91 GLENEIDA AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-1222
Practice Address - Country:US
Practice Address - Phone:845-228-7000
Practice Address - Fax:845-228-5485
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-10-31
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NYX6750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU60043Medicare UPIN
NYX39511Medicare ID - Type Unspecified