Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36001391N | OH |
Y | 222Z00000X | Podiatrist | 36001391N | OH |
NPI | 1053349894 |
---|---|
Provider Name | Dr. Joel Novack |
First Address | Solon, OH 44139-8660 |
Second Address | Warrensville Heights, OH 44122-6805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 22/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0525800 | (05) | OH |
T80307 | (02) | OH |