Provider Demographics
NPI:1811956493
Name:NOVAK, SUE-ANN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:SUE-ANN
Middle Name:ELIZABETH
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 1:3173 CHILI AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5400
Mailing Address - Country:US
Mailing Address - Phone:585-889-0750
Mailing Address - Fax:585-889-0759
Practice Address - Street 1:3173 CHILI AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5400
Practice Address - Country:US
Practice Address - Phone:585-889-0750
Practice Address - Fax:585-889-0759
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02922952Medicaid
NY02922952Medicaid
NYRB6388- BA0017 GROUPMedicare PIN