MEDICARE: DR. SHERIE LYNN 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	208000000X	Pediatrics Physician	25MA07664400	NJ
2	2084N0400X	Neurology Physician	25MA07664400	NJ
3	2084P0804X	Child & Adolescent Psychiatry Physician	25MA07664400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942218607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERIE LYNN NOVOTNY MD

Provider Business Mailing Address
First Line	:	66 WEST GILBERT ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701
Country	:	US
Telephone Number	:	732-212-0051
Fax Number	:	732-212-0713

Provider Business Practice Location Address
First Line	:	671 HOES LN W
Second Line	:	RM D439
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-8021
Country	:	US
Telephone Number	:	732-235-6800
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	04/08/2024

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