Provider Demographics
NPI:1598773269
Name:NOVELLA, THOMAS MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:NOVELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PERRY ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2382
Mailing Address - Country:US
Mailing Address - Phone:212-645-5640
Mailing Address - Fax:212-664-6072
Practice Address - Street 1:343 W 58TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1108
Practice Address - Country:US
Practice Address - Phone:212-506-0242
Practice Address - Fax:212-664-8072
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002867213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP33341Medicare ID - Type Unspecified
NYT50962Medicare UPIN