Provider Demographics
NPI:1316568728
Name:NOVICK, ANDREW MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARK
Last Name:NOVICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:30 S ADELAIDE AVE APT PHB
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1606
Mailing Address - Country:US
Mailing Address - Phone:516-974-4511
Mailing Address - Fax:
Practice Address - Street 1:15050 ELDERBERRY LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8504
Practice Address - Country:US
Practice Address - Phone:866-785-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1007382084N0400X
NY3050842084N0400X
NH222662084N0400X
MO20210462652084N0400X
PAOS0220302084N0400X
ORDO2072082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology