Provider Demographics
NPI:1952661167
Name:NOVICK, JEFF (RD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:NOVICK
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E SHERIDAN ST
Mailing Address - Street 2:#210
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-5553
Mailing Address - Country:US
Mailing Address - Phone:954-732-8828
Mailing Address - Fax:
Practice Address - Street 1:399 E SHERIDAN ST
Practice Address - Street 2:#210
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-5553
Practice Address - Country:US
Practice Address - Phone:954-732-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered