Provider Demographics
NPI:1497644421
Name:NOVELLA MED CROWNS
Entity type:Organization
Organization Name:NOVELLA MED CROWNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-593-4019
Mailing Address - Street 1:101 E GIBBSBORO RD APT 1311
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2500
Practice Address - Country:US
Practice Address - Phone:856-593-4019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier