| Initia Nova LLC | |
|
1930 Marlton Pike E Ste H42 Cherry Hill NJ 08003-4104 | |
| (856) 425-2942 | |
| Not Available |
| Full Name | Initia Nova LLC |
|---|---|
| Speciality | Specialist |
| Location | 1930 Marlton Pike E Ste H42, Cherry Hill, New Jersey |
| Authorized Official Name and Position | Patrick O Sullivan (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 8566258563 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Initia Nova LLC 1930 Marlton Pike E Ste H42 Cherry Hill NJ 08003-4104 Ph: (856) 425-2942 | Initia Nova LLC 1930 Marlton Pike E Ste H42 Cherry Hill NJ 08003-4104 Ph: (856) 425-2942 |
| NPI Number | 1013461243 |
|---|---|
| Provider Enumeration Date | 08/04/2016 |
| Last Update Date | 08/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013461243 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 37F100176500 (New Jersey) | Secondary |
| 174400000X | Specialist | (New Jersey) | Primary |
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