Provider Demographics
NPI:1023008091
Name:NOVAKHOV, ALEKSEY (DDS)
Entity Type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:NOVAKHOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WINFIELD SCOTT PLZ
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2443
Mailing Address - Country:US
Mailing Address - Phone:908-353-5400
Mailing Address - Fax:908-353-7273
Practice Address - Street 1:611 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-1203
Practice Address - Country:US
Practice Address - Phone:908-353-5400
Practice Address - Fax:908-353-7273
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02059900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020079Medicaid