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General NPI Number Information
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NPI Number | 1740419258
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Entity Type | Individual
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Provider Name | MARIO ALBERTO NOVA RPAC
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Gender | Male
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 760 BROADWAY
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City | BROOKLYN
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State | NY
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Zip | 11206-5317
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Country | US
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Telephone | 718-963-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 HANCOCK AVE
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City | FRANKLIN SQ
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State | NY
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Zip | 11010-2105
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Country | US
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Telephone | 718-877-8606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 013119
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License Number State | NY
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