Provider Demographics
NPI:1578186805
Name:NOVICK, NICOLAS PATRICK GOLDSTEIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:PATRICK GOLDSTEIN
Last Name:NOVICK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:NICOLAS
Other - Middle Name:PATRICK NOVICK
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics