Provider Demographics
NPI:1134284953
Name:NOVICK, ELLEN SOBERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:SOBERMAN
Last Name:NOVICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 FLORAL CT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2607
Mailing Address - Country:US
Mailing Address - Phone:908-233-2732
Mailing Address - Fax:908-233-2320
Practice Address - Street 1:225 STATE ROUTE 35
Practice Address - Street 2:SUITE 208
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5919
Practice Address - Country:US
Practice Address - Phone:732-380-0881
Practice Address - Fax:732-380-0886
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50022208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7485808Medicaid
C10892Medicare UPIN
NJ531323Medicare ID - Type Unspecified