Healthcare Provider Details

I. General information

NPI: 1265229058
Provider Name (Legal Business Name): EMMA NOVY NP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WIDGER RD
MARBLEHEAD MA
01945-2146
US

IV. Provider business mailing address

200 QUANNAPOWITT PKWY
WAKEFIELD MA
01880-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-631-5126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2390175
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2390175
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: