Provider Demographics
NPI:1053349894
Name:NOVACK, JOEL (DPM)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:NOVACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391660
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-8660
Mailing Address - Country:US
Mailing Address - Phone:440-944-6665
Mailing Address - Fax:440-944-6672
Practice Address - Street 1:20050 HARVARD ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6805
Practice Address - Country:US
Practice Address - Phone:216-491-9157
Practice Address - Fax:216-491-7245
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001391N213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0525800Medicaid
OHT80307Medicare UPIN
OH0525800Medicaid
OH480020400Medicare PIN
OHNO0012802Medicare PIN