Provider Demographics
NPI:1457028383
Name:NOVIKOVA, ANASTASIA V
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:V
Last Name:NOVIKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E 13TH ST APT 5L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2823
Mailing Address - Country:US
Mailing Address - Phone:347-634-1759
Mailing Address - Fax:
Practice Address - Street 1:2148 OCEAN AVE STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1484
Practice Address - Country:US
Practice Address - Phone:718-375-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2620285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY885649008OtherDRIVER LICENSE