MEDICARE: PAUL L NOVOTNY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	131982	NY

General Provider Information

NPI Number	:	1568459501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL L NOVOTNY MD

Provider Business Mailing Address
First Line	:	12 N 7TH AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2026
Country	:	US
Telephone Number	:	914-361-6055
Fax Number	:	914-664-0456

Provider Business Practice Location Address
First Line	:	12 N 7TH AVE
Second Line	:	MOUNT VERNON HOSP
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2026
Country	:	US
Telephone Number	:	914-664-8000
Fax Number	:	914-664-0456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	01/19/2014

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