Provider Demographics
NPI:1891951901
Name:ETTA NOVICK MD & ISAAC M NOVICK MD PC
Entity Type:Organization
Organization Name:ETTA NOVICK MD & ISAAC M NOVICK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPP
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-934-9720
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:AMTS BILLING
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0332
Mailing Address - Country:US
Mailing Address - Phone:718-338-3030
Mailing Address - Fax:
Practice Address - Street 1:1821 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3808
Practice Address - Country:US
Practice Address - Phone:718-338-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty