Provider Demographics
NPI:1649383142
Name:NOVICK, NELSON LEE (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:LEE
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 1:328 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3317
Mailing Address - Country:US
Mailing Address - Phone:212-772-9300
Mailing Address - Fax:212-772-0524
Practice Address - Street 1:328 E 75TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3317
Practice Address - Country:US
Practice Address - Phone:212-772-9300
Practice Address - Fax:212-772-0524
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1279411207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00428991Medicaid
NY20A741Medicare ID - Type Unspecified
B10906Medicare UPIN