MEDICARE: NOVA 1 CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PH25630	FL

General Provider Information

NPI Number	:	1003845868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA 1 CORP

Provider Business Mailing Address
First Line	:	1234 S DIXIE HWY
Second Line	:	SUITE 324
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2902
Country	:	US
Telephone Number	:	305-662-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3692 GRAND AVE
Second Line	:	STE B
City	:	MIAMI
State	:	FL
Zip	:	33133-4953
Country	:	US
Telephone Number	:	305-662-4477
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAYMOND G WEISBEIN
Credential	:
Telephone Number	:	305-662-4477

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	01/29/2013

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Directions to “NOVA 1 CORP ” Practice Location

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