Basic Information
| Provider Information | |||||||||
| NPI: | 1164800637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVAK | ||||||||
| FirstName: | CRISTINA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 N BROAD ST RM 1A | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191404106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269019 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3401 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157073133 | ||||||||
| FaxNumber: | 2157073945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2015 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MT208728 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | A169430 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | MD478892 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.