Basic Information
| Provider Information | |||||||||
| NPI: | 1154455509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVAL | ||||||||
| FirstName: | NINA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10470 QUEENS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182756010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 97-45 QUEENS BLV. | ||||||||
| Address2: | PH FLOOR | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188969090 | ||||||||
| FaxNumber: | 7188300724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | P09597 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.