Provider Demographics
NPI:1265586564
Name:JOEL NOVACK DPM, INC
Entity type:Organization
Organization Name:JOEL NOVACK DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-491-9151
Mailing Address - Street 1:PO BOX 391660
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-8660
Mailing Address - Country:US
Mailing Address - Phone:216-491-9151
Mailing Address - Fax:440-491-7243
Practice Address - Street 1:20050 HARVARD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6816
Practice Address - Country:US
Practice Address - Phone:216-491-9151
Practice Address - Fax:216-491-7243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOEL NOVACK DPM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001391213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0229032Medicaid
OHT80307Medicare UPIN
OH4488050001Medicare NSC
OH0229032Medicaid
OHCG2526Medicare PIN