Provider Demographics
NPI:1164666012
Name:NOVAK, LAURA J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHEPPARD RD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4608
Mailing Address - Country:US
Mailing Address - Phone:856-470-7499
Mailing Address - Fax:856-229-9941
Practice Address - Street 1:1 SHEPPARD RD
Practice Address - Street 2:SUITE 703
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4608
Practice Address - Country:US
Practice Address - Phone:856-470-7499
Practice Address - Fax:856-229-9941
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA099346002084P0800X
PAMD4465372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry