Provider Demographics
NPI:1710190343
Name:NOVAK, LEON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:MICHAEL
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-488-6500
Mailing Address - Fax:856-488-6507
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-488-6500
Practice Address - Fax:856-488-6507
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2433232085D0003X, 2085R0202X
PAMD4341302085R0202X
DEC1-00091112085R0202X
NJ25MA098281002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1710190343Medicaid
NYJ400021276Medicare UPIN
DE166397ZAQWMedicare PIN
NYP00857186OtherRR MEDICARE
DE1710190343OtherRR MEDICARE
NY02874064Medicaid