Healthcare Provider Details

I. General information

NPI: 1598271744
Provider Name (Legal Business Name): STEPHEN A NOVELLI, DC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ORCHARD PARK RD # B
BUFFALO NY
14224-4658
US

IV. Provider business mailing address

PO BOX 1360
ORCHARD PARK NY
14127-8360
US

V. Phone/Fax

Practice location:
  • Phone: 716-573-6666
  • Fax:
Mailing address:
  • Phone: 716-573-6666
  • Fax: 716-805-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN NOVELLI
Title or Position: OWNER, PRESIDENT
Credential: DC
Phone: 716-573-6666