Provider Demographics
NPI:1801831763
Name:BOVER, EDUARD (DO)
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:BOVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-745-0500
Mailing Address - Fax:516-745-1534
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-745-0500
Practice Address - Fax:516-745-1534
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231401207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02826608Medicaid
NYI62152Medicare UPIN