Provider Demographics
NPI:1760828503
Name:NOVAK, JODI (DVM)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:MRS
Other - First Name:JODI
Other - Middle Name:NOVAK
Other - Last Name:WEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:35 FAWN RD
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1515
Mailing Address - Country:US
Mailing Address - Phone:518-761-2602
Mailing Address - Fax:
Practice Address - Street 1:35 FAWN RD
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1515
Practice Address - Country:US
Practice Address - Phone:518-761-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008531174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian