Initia Nova Medical Solutions

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

25MB08239800 Issued in NJ

Legal business name

INITIA NOVA MEDICAL SOLUTIONS

Practice address

1930 Marlton Pike E
Cherry Hill, NJ 08003-2150

Phone

(856) 446-6961

NPI assigned

Nov 7, 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

Owner

Phone

(856) 625-8563

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1215479308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 MARLTON PIKE E",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080032150",
            "telephone_number": "856-446-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 MARLTON PIKE E",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080032150",
            "telephone_number": "856-446-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INITIA NOVA MEDICAL SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-625-8563",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NJ",
            "license": "25MB08239800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Internal Medicine) Physician in Cherry Hill, NJ
• Providers in Cherry Hill, NJ by specialty
• Addiction Medicine (Internal Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.