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NPI Code Detail

MEDICARE: MS. BETHANY NOVAK FNP

MEDICARE: MS. BETHANY NOVAK FNP
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center330008-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111350513OTHERNYCAQH

General Provider Information

NPI Number : 1093736696
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETHANY NOVAK FNP
Provider Business Mailing Address
First Line : 312 E 94TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10128-5604
Country : US
Telephone Number : 212-423-2900
Fax Number : 212-423-2920
Provider Business Practice Location Address
First Line : 312 E 94TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10128-5604
Country : US
Telephone Number : 212-423-2900
Fax Number : 212-423-2920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 07/08/2007

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