Healthcare Provider Details

I. General information

NPI: 1750315198
Provider Name (Legal Business Name): GREGORY R NOVOTNY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 CYPRESS POINT DR
EGG HARBOR CITY NJ
08215-5124
US

IV. Provider business mailing address

649 CYPRESS POINT DR
EGG HARBOR CITY NJ
08215-5124
US

V. Phone/Fax

Practice location:
  • Phone: 609-442-4745
  • Fax: 609-965-0229
Mailing address:
  • Phone: 609-442-4745
  • Fax: 609-965-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB05370500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: