Provider Demographics
NPI:1700880341
Name:KOWALSKY, STEPHEN ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:KOWALSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LAFAYETTE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3575
Mailing Address - Country:US
Mailing Address - Phone:973-729-7755
Mailing Address - Fax:973-729-0677
Practice Address - Street 1:21 LAFAYETTE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3575
Practice Address - Country:US
Practice Address - Phone:973-729-7755
Practice Address - Fax:973-729-0677
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00390300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521380Medicare PIN
NJU26884Medicare UPIN
NJ0171090001Medicare NSC