Healthcare Provider Details

I. General information

NPI: 1306820873
Provider Name (Legal Business Name): NOVIS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 DIVISADERO ST
SAN FRANCISCO CA
94115-3012
US

IV. Provider business mailing address

1712 DIVISADERO ST
SAN FRANCISCO CA
94115-3012
US

V. Phone/Fax

Practice location:
  • Phone: 415-440-0444
  • Fax: 415-440-0441
Mailing address:
  • Phone: 415-440-0444
  • Fax: 415-440-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1433
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC17444
License Number StateMD

VIII. Authorized Official

Name: MR. GARY VAYSBERG
Title or Position: PRESIDENT
Credential: CPED
Phone: 415-440-0444