Provider Demographics
NPI:1336581073
Name:NOVAK, ASHLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAWRENCE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3618
Mailing Address - Country:US
Mailing Address - Phone:518-798-9985
Mailing Address - Fax:518-761-7043
Practice Address - Street 1:1 LAWRENCE ST STE 2
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3618
Practice Address - Country:US
Practice Address - Phone:518-798-9985
Practice Address - Fax:518-761-7043
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 016748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant