Provider Demographics
NPI:1649299934
Name:NOVAK, NELLIE (MD)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 FEDERAL STREET
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-541-5933
Mailing Address - Fax:856-541-3340
Practice Address - Street 1:817 FEDERAL STREET,
Practice Address - Street 2:SUITE 300
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-541-5933
Practice Address - Fax:856-541-3340
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05354100174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2105705Medicaid
NJ089971ABNMedicare ID - Type Unspecified
NJ2105705Medicaid