Provider Demographics
NPI:1124329537
Name:NOVAK, LISA (DNP, NPP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DNP, NPP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PONGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPP
Mailing Address - Street 1:1585 CENTRAL PARK AVE UNIT 25
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7402
Mailing Address - Country:US
Mailing Address - Phone:914-771-4009
Mailing Address - Fax:914-771-4110
Practice Address - Street 1:35 E GRASSY SPRAIN RD STE 304B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4618
Practice Address - Country:US
Practice Address - Phone:914-771-4009
Practice Address - Fax:914-771-4110
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health