Initia Nova LLC

NPI #1013461243 in Cherry Hill, New Jersey

Provider Information

NPI Number: 1013461243
Entity Type: Organization
Organization Name: Initia Nova LLC
Primary Specialty: Specialist
Enumeration Date: Aug 4, 2016
Last Updated: Aug 4, 2016

Practice Location

Address: 1930 MARLTON PIKE E STE H42
City: Cherry Hill
State: New Jersey
ZIP Code: 08003-4104
Phone: (856) 425-2942

Authorized Official

Name: DR. PATRICK O SULLIVAN, D.O.
Title: CHIEF MEDICAL OFFICER
Phone: (856) 625-8563

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Specialist	174400000X	Primary

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