Healthcare Provider Details

I. General information

NPI: 1386492262
Provider Name (Legal Business Name): NOVELLI WELLNESS CHIROPRACTIC PHYSICAL THERAPY AND NURSE PRACTITIONER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ORCHARD PARK RD
WEST SENECA 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:
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN NOVELLI
Title or Position: MANAGING MEMBER, CEO
Credential: DC
Phone: 716-573-6666