Healthcare Provider Details

I. General information

NPI: 1720764616
Provider Name (Legal Business Name): CHLOE ALEXA NOVAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 2E99
NEWARK DE
19718-2200
US

IV. Provider business mailing address

5604 PARADE FIELD WAY
LANSDALE PA
19446
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-5982
  • Fax: 302-733-6081
Mailing address:
  • Phone: 215-450-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011964
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: