Provider Demographics
NPI:1215039037
Name:NOVICK, BRIAN ELKINS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ELKINS
Last Name:NOVICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 QUEENS BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7206
Mailing Address - Country:US
Mailing Address - Phone:516-426-8604
Mailing Address - Fax:718-261-2285
Practice Address - Street 1:11821 QUEENS BLVD STE 601
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7206
Practice Address - Country:US
Practice Address - Phone:516-426-8604
Practice Address - Fax:718-261-2285
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1400702080P0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB11263Medicare UPIN
NY23D87Medicare PIN