Provider Demographics
NPI:1811409386
Name:LISA NOVAK, NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:LISA NOVAK, NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NPP-BC
Authorized Official - Phone:914-771-4009
Mailing Address - Street 1:1585 CENTRAL PARK AVE UNIT 25
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7402
Mailing Address - Country:US
Mailing Address - Phone:914-771-4009
Mailing Address - Fax:914-771-4110
Practice Address - Street 1:35 E GRASSY SPRAIN RD STE 304B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4618
Practice Address - Country:US
Practice Address - Phone:914-771-4009
Practice Address - Fax:914-771-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty