Provider Demographics
NPI:1194881094
Name:NOVAK, DENNIS EARL (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EARL
Last Name:NOVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:EARL
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1001 LACEY ROAD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-0780
Mailing Address - Country:US
Mailing Address - Phone:609-693-8900
Mailing Address - Fax:609-971-2888
Practice Address - Street 1:1001 LACEY ROAD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-0780
Practice Address - Country:US
Practice Address - Phone:609-693-8900
Practice Address - Fax:609-971-2888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03039400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD01825500OtherCDS #
NJ0699209Medicaid
NJ25MA03039400OtherLICENSE #
NJ25MA03039400OtherLICENSE #
NJ0699209Medicaid
NJD01825500OtherCDS #