Healthcare Provider Details

I. General information

NPI: 1528238037
Provider Name (Legal Business Name): JOSEPH P. NOVEK DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 E GENESEE ST
FAYETTEVILLE NY
13066-1036
US

IV. Provider business mailing address

6950 E GENESEE ST
FAYETTEVILLE NY
13066-1036
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-1020
  • Fax:
Mailing address:
  • Phone: 315-446-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN00030470
License Number StateNY

VIII. Authorized Official

Name: MS. LISA RYCRAFT
Title or Position: SEC
Credential:
Phone: 315-446-1020