1558371302 NPI number — MALORIE KOSHT NOVAK PT

Table of content: MALORIE KOSHT NOVAK PT (NPI 1558371302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558371302 NPI number — MALORIE KOSHT NOVAK PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOVAK
Provider First Name:
MALORIE
Provider Middle Name:
KOSHT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOSHT
Provider Other First Name:
MALORIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558371302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 GREGORY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH AUGUSTA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29860-9705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 AUSTIN GRAYBILL RD
Provider Second Line Business Practice Location Address:
NHC HEALTHCARE, NORTH AUGUSTA
Provider Business Practice Location Address City Name:
NORTH AUGUSTA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-278-4272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT008463 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)