Provider Demographics
NPI:1588812846
Name:KOVALOVICH, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KOVALOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MCCLELLAN ST STE G01
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1024
Mailing Address - Country:US
Mailing Address - Phone:518-347-5655
Mailing Address - Fax:518-347-5656
Practice Address - Street 1:624 MCCLELLAN ST STE G01
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1024
Practice Address - Country:US
Practice Address - Phone:518-347-5655
Practice Address - Fax:518-347-5656
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001079231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3019900OtherMVP
NY03686028Medicaid
NY000494921003OtherBLUE SHIELD OF NENY
NY200245431OtherCDPHP
NYM93091OtherEMPIRE BLUE CROSS