NPIMap

Organization Active NPI

Brian J Novack DPM

  • Foot Surgery Podiatrist
  • Wickliffe, OH
National Provider Identifier
1316092844
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
36001391N Issued in OH
Legal business name
BRIAN J NOVACK DPM
Practice address
29630 Euclid Ave
Wickliffe, OH 44092-1829
Phone
(440) 944-6665
Fax
(440) 944-6672
NPI assigned
Jan 24, 2007
Last updated
Nov 1, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2007

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

Authorized official

Name
Mr. Brian J Novack, DPMNPI 1598762924
Title
President
Phone
(440) 944-6665

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X 36001391N OH Primary

Addresses

Primary practice location

29630 Euclid Ave
Wickliffe, OH 44092-1829

Mailing address

29630 Euclid Ave
Wickliffe, OH 44092-1829
Phone (440) 944-6665

Other identifiers 3

IdentifierTypeStateIssuer
000000288591OtherOHBCBS
2146270MedicaidOH
275645717008OtherOHMEDICAL MUTUAL

Other names 1

  • Brian J Novack DPM INC Other name

National Provider Directory

National Provider Directory
Tax ID family
Brian J Novack DPM Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1316092844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29630 EUCLID AVE",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440921829",
            "telephone_number": "440-944-6665",
            "fax_number": "440-944-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29630 EUCLID AVE",
            "city": "WICKLIFFE",
            "state": "OH",
            "postal_code": "440921829",
            "telephone_number": "440-944-6665",
            "fax_number": "440-944-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN J NOVACK DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "NOVACK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-944-6665",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "OH",
            "license": "36001391N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000288591",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2146270",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "275645717008",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brian J Novack DPM INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wickliffe, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.