Larry Ira Novak, MD.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

129876 Issued in NY

Practice address

4104 Medical Center Dr
Suite 104
Fayetteville, NY 13066-6635

Phone

(315) 663-0059

Fax

(315) 663-0123

NPI assigned

Jul 24, 2006

Last updated

Jan 9, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389225600000",
    "number": "1750303913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5112 WEST TAFT ROAD",
            "address_2": "SUITE L",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "13088",
            "telephone_number": "315-452-2500",
            "fax_number": "315-452-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4104 MEDICAL CENTER DR",
            "address_2": "SUITE 104",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666635",
            "telephone_number": "315-663-0059",
            "fax_number": "315-663-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVAK",
        "first_name": "LARRY",
        "middle_name": "IRA",
        "credential": "MD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2014-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "129876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00482435",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Elizabeth Kimmel Neidig, FNP-C
• Derek P Nguyen, DDS
• Kelly Hannon Nichols, LCSW-R
• Cosmina Olariu Nolan, DDS
• North Medical Cardiovascular Group PC (Cardiovascular Group of Syracuse)
• Joseph P Novek, DPM
• Paul F. Nozynski, D.D.S.,P.C.
• Anita D O'Malley, PA
• Mark A Oberferst, DDS
• Navpriya Oberoi, MD

• Family Medicine Physician in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; 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.