Healthcare Provider Details

I. General information

NPI: 1669558466
Provider Name (Legal Business Name): JOSEPH P NOVEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 EAST GENESEE ST
FAYETTEVILLE NY
13066
US

IV. Provider business mailing address

6950 EAST GENESEE ST
FAYETTEVILLE NY
13066
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-1020
  • Fax: 315-445-2952
Mailing address:
  • Phone: 315-446-1020
  • Fax: 315-445-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: