=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053405647
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY MELISSA NOVATT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3712 US-44
-----------------------------------------------------
City | MILLBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-516-4684
-----------------------------------------------------
Fax | 845-876-2627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6250 ROUTE 9
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-3629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 458-516-4684
-----------------------------------------------------
Fax | 845-876-2627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 199414
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------