Individual
MS. BETHANY NOVAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
312 E 94TH ST, NEW YORK, NY 10128-5604
(212) 423-2900
(212) 423-2920
Mailing address
312 E 94TH ST, NEW YORK, NY 10128-5604
(212) 423-2900
(212) 423-2920
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
330008-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11350513
CAQH
NY
Enumeration date
07/21/2006
Last updated
07/08/2007
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