Basic Information
| Provider Information | |||||||||
| NPI: | 1164782694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVALSKY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 HURFVILLE-CROSSKEYS RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562185634 | ||||||||
| FaxNumber: | 8562185664 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 HURFVILLE-CROSSKEYS RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562185634 | ||||||||
| FaxNumber: | 8562185664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2012 | ||||||||
| LastUpdateDate: | 02/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MB097006900 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1164782694 | 01 | NJ | NPI | OTHER |