Provider Demographics
NPI:1750382966
Name:KOVOOR, JOHNNY G
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:G
Last Name:KOVOOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4221
Mailing Address - Country:US
Mailing Address - Phone:914-237-8282
Mailing Address - Fax:914-237-8575
Practice Address - Street 1:30 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4221
Practice Address - Country:US
Practice Address - Phone:914-237-8282
Practice Address - Fax:914-237-8575
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228788174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02466448Medicaid
NY5996377OtherGHI PPO #
NYP2927478OtherOXFORD#
NY1310P12OtherEMPIRE BC/BS (NEW YORK) #
NY228788OtherHIP#
NY000000095726OtherGHI HMO #
NY1310P1OtherEMPIRE BC/BS (YONKERS) #
NYI01871Medicare UPIN
NY0287P1Medicare PIN