Active NPI
Jess Nowak Jr.
- Clinical Social Worker
- Buffalo, MN
National Provider Identifier
1982230744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 25704
- Practice address
- 102 Marty Dr Ste 2
Buffalo, MN 55313-9345 - Phone
- (763) 682-5420
- Fax
- (763) 682-5803
- NPI assigned
- Mar 12, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 25704 | MN | Primary |
Addresses
Primary practice location
102 Marty Dr Ste 2
Buffalo, MN 55313-9345
Mailing address
102 Marty Dr Ste 2
Buffalo, MN 55313-9345
Phone (763) 682-5420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25704 | MN | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583971200000",
"number": "1982230744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 MARTY DR STE 2",
"city": "BUFFALO",
"state": "MN",
"postal_code": "553139345",
"telephone_number": "763-682-5420",
"fax_number": "763-682-5803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 MARTY DR STE 2",
"city": "BUFFALO",
"state": "MN",
"postal_code": "553139345",
"telephone_number": "763-682-5420",
"fax_number": "763-682-5803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOWAK",
"first_name": "JESS",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-12",
"last_updated": "2020-03-12",
"certification_date": "2020-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "25704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.