Individual provider Active NPI

Gay R Novack, LCSW

  • Clinical Social Worker
  • Oceanside, NY
National Provider Identifier
1306978168
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
PR021424-1 Issued in NY
Practice address
540 Fir PL
Oceanside, NY 11572-4708
Phone
(516) 678-3048
Fax
(516) 594-9592
NPI assigned
Mar 9, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X PR021424-1 NY Primary

Addresses

Primary practice location

540 Fir PL
Oceanside, NY 11572-4708

Mailing address

540 Fir PL
Oceanside, NY 11572-4708
Phone (516) 678-3048

Other identifiers 1

IdentifierTypeStateIssuer
02034182MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100419000214 NY Practitioner - Clinical Social Worker 8022145317 Practice locations: Oceanside, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

540 Fir PL
Oceanside, NY 11572-4708

540 Fir Place
Oceanside, NY 11572-4708
Phone (516) 678-3048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PR021424-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306978168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 FIR PL",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115724708",
            "telephone_number": "516-678-3048",
            "fax_number": "516-594-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 FIR PL",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115724708",
            "telephone_number": "516-678-3048",
            "fax_number": "516-594-9592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVACK",
        "first_name": "GAY",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PR021424-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02034182",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, NY

Sources for this page

Verify at the official NPI Registry.