Provider Demographics
NPI:1164058889
Name:MARKOVETZ, NOAH MICHAEL
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:MICHAEL
Last Name:MARKOVETZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 BUCKINGHAM ST APT 10
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2122
Mailing Address - Country:US
Mailing Address - Phone:913-240-9160
Mailing Address - Fax:
Practice Address - Street 1:2225 BUCKINGHAM ST APT 10
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2122
Practice Address - Country:US
Practice Address - Phone:913-240-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician