Individual
IKA NOVIAWATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
725 ALBANY STREET, SUITE 7B, SHAPIRO BUILDING, BOSTON, MA 02118
(617) 638-8456
(617) 638-8465
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
Primary
265068
MA
2084N0400X
Neurology Physician
265068
MA
2084N0600X
Clinical Neurophysiology Physician
265068
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110108436A
—
MA
05
—
3104891
—
NH
Enumeration date
04/06/2009
Last updated
07/08/2024
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