Provider Demographics
NPI:1114704285
Name:NOVA FAMILY HEALTH NP, PC
Entity type:Organization
Organization Name:NOVA FAMILY HEALTH NP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:516-587-4541
Mailing Address - Street 1:32 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2257
Practice Address - Country:US
Practice Address - Phone:516-308-7405
Practice Address - Fax:516-308-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY347927OtherSTATE LICENSE
NY07863734Medicaid
NYA400294812OtherMEDICARE