Healthcare Provider Details

I. General information

NPI: 1780976332
Provider Name (Legal Business Name): LAURA JOYCE NOVELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 AVENUE AT THE CMN STE 7B
SHREWSBURY NJ
07702-4569
US

IV. Provider business mailing address

180 AVENUE AT THE CMN STE 7B
SHREWSBURY NJ
07702-4569
US

V. Phone/Fax

Practice location:
  • Phone: 732-935-7143
  • Fax: 732-935-7245
Mailing address:
  • Phone: 732-935-7143
  • Fax: 732-935-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10126800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25MA10126800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: