Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 26NJ01113100 | NJ |
NPI | 1013501873 |
---|---|
Provider Name | Cynthia M Novak |
First Address | Kenilworth, NJ 07033-1409 |
Second Address | Kenilworth, NJ 07033-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |