NPI 1013461243

Initia Nova LLC

Organisation Specialist Cherry Hill, NJ

Practice location

Address: 1930 Marlton Pike E STE H42, Cherry Hill, NJ 08003-4104
Phone: (856) 425-2942

Authorised official

Name: Patrick O Sullivan
Title: Chief Medical Officer
Phone: (856) 625-8563

Registered specialties (2)

Specialist Primary

Other Service Providers Taxonomy 174400000X

Other Specialist providers in New Jersey →

Mental Health Clinic/Center (Including Community Mental Health Center)

Ambulatory Health Care Facilities Taxonomy 261QM0801X Licence 37F100176500 (NJ)

Other Clinic/Center providers in New Jersey →

Registry record

NPI: 1013461243
Entity type: Organization
NPI issued: 4 Aug 2016
Record last updated: 4 Aug 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.