Provider Demographics
NPI:1568274728
Name:BOVA, LIAM J (LPN)
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:J
Last Name:BOVA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MONTFORT RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3517
Mailing Address - Country:US
Mailing Address - Phone:845-793-3247
Mailing Address - Fax:
Practice Address - Street 1:41 PAGE PARK DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7500
Practice Address - Country:US
Practice Address - Phone:845-486-2850
Practice Address - Fax:845-486-2770
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345017-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse