Provider Demographics
NPI:1609224153
Name:CORVITALS, INC.
Entity Type:Organization
Organization Name:CORVITALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-401-9998
Mailing Address - Street 1:P.O. BOX 270
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565
Mailing Address - Country:US
Mailing Address - Phone:888-401-9998
Mailing Address - Fax:800-559-3413
Practice Address - Street 1:590 NICHOLS ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729
Practice Address - Country:US
Practice Address - Phone:888-401-9998
Practice Address - Fax:800-559-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory