Initia Nova LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

INITIA NOVA LLC

Practice address

1930 Marlton Pike E Ste H42
Cherry Hill, NJ 08003-4104

Phone

(856) 425-2942

NPI assigned

Aug 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Patrick O Sullivan, D.O.

Title

Chief Medical Officer

Phone

(856) 625-8563

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470268800000",
    "number": "1013461243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 MARLTON PIKE E STE H42",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080034104",
            "telephone_number": "856-425-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 MARLTON PIKE E STE H42",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080034104",
            "telephone_number": "856-425-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INITIA NOVA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-04",
        "last_updated": "2016-08-04",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "856-625-8563",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NJ",
            "license": "37F100176500",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Cherry Hill, NJ
• Providers in Cherry Hill, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.