Healthcare Provider Details

I. General information

NPI: 1598794661
Provider Name (Legal Business Name): NINEL NOVAK R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BATTERY AVE
BROOKLYN NY
11228-3550
US

IV. Provider business mailing address

8004 10TH AVE
BROOKLYN NY
11228-2902
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-5706
  • Fax:
Mailing address:
  • Phone: 347-260-0083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: