Healthcare Provider Details

I. General information

NPI: 1790608602
Provider Name (Legal Business Name): NOVA SURGICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 , US ROUTE 9 SUITE #201
MALTA NY
12020
US

IV. Provider business mailing address

2452 , US ROUTE 9 SUITE #201
MALTA NY
12020
US

V. Phone/Fax

Practice location:
  • Phone: 518-860-6271
  • Fax:
Mailing address:
  • Phone: 518-860-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VISHNUDAS PAI
Title or Position: OWNER
Credential:
Phone: 518-860-6271