Organization
NKY MED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY DAVID GAVORNIK (DIRECTOR OF DEVELOPMENT)
(908) 619-0346
Entity
Organization
Contact information
Practice address
1717 MADISON AVE, COVINGTON, KY 41011-3330
(859) 613-3722
Mailing address
1717 MADISON AVE, COVINGTON, KY 41011-3330
(859) 613-3722
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
KY
Other
Enumeration date
05/10/2013
Last updated
05/10/2013
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