Provider Demographics
NPI:1619426632
Name:KOVNER, HAYLEY NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:NICOLE
Last Name:KOVNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 68TH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5995
Mailing Address - Country:US
Mailing Address - Phone:212-570-9595
Mailing Address - Fax:646-658-4662
Practice Address - Street 1:116 E 68TH ST APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5995
Practice Address - Country:US
Practice Address - Phone:212-570-9595
Practice Address - Fax:646-658-4662
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant