Provider Demographics
NPI:1477567790
Name:NOVA FAMILY PODIATRY P.C.
Entity Type:Organization
Organization Name:NOVA FAMILY PODIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVABILSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-631-3338
Mailing Address - Street 1:3125 RIDGE PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1407
Mailing Address - Country:US
Mailing Address - Phone:610-631-3338
Mailing Address - Fax:610-631-0313
Practice Address - Street 1:3125 RIDGE PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1407
Practice Address - Country:US
Practice Address - Phone:610-631-3338
Practice Address - Fax:610-631-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004124L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480035187Medicare PIN
PA4742760001Medicare NSC