Basic Information
| Provider Information | |||||||||
| NPI: | 1730346818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOWAK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 TOWNSEND AVE UNIT 140 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065123178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036409550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 HOWARD AVE LOWR LEVEL | ||||||||
| Address2: | YALE SCHOOL OF MEDICINE, DEPARTMENT OF NEUROLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854085 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2008 | ||||||||
| LastUpdateDate: | 07/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | AY26291556842 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2084N0400X | AY26291556842 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | AY26291556842 | 01 | CT | DEA # | OTHER |