MEDICARE: JENNIFER NOVAKOVIC PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1639583412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NOVAKOVIC PA-C

Provider Business Mailing Address
First Line	:	54 SEWARD ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 SEWARD ST
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1143
Country	:	US
Telephone Number	:	518-581-2860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	05/08/2017

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