Basic Information
| Provider Information | |||||||||
| NPI: | 1356720650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVACK | ||||||||
| FirstName: | SHIRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 WALNUT ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179880090 | ||||||||
| FaxNumber: | 7172215320 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 WALNUT ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179880090 | ||||||||
| FaxNumber: | 7172215320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2015 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 293706 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080P0205X | MD475026 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.