Provider Demographics
NPI:1063923829
Name:NOVA HEALTHCARE MANAGEMENT LLC
Entity type:Organization
Organization Name:NOVA HEALTHCARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:MUSTELIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-983-1959
Mailing Address - Street 1:241 MAIN ST FL 4
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5715
Mailing Address - Country:US
Mailing Address - Phone:201-880-8398
Mailing Address - Fax:
Practice Address - Street 1:241 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5715
Practice Address - Country:US
Practice Address - Phone:201-880-8398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service