Provider Demographics
NPI:1093789349
Name:NOVICKI, DAVID C (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:NOVICKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3413
Mailing Address - Country:US
Mailing Address - Phone:203-874-6755
Mailing Address - Fax:203-877-7849
Practice Address - Street 1:32 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3413
Practice Address - Country:US
Practice Address - Phone:203-874-6755
Practice Address - Fax:203-877-7849
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000133213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0706090003OtherMEDICARE DMERC
T23029Medicare UPIN