Provider Demographics
NPI:1184094955
Name:HORNICK, NOAH (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:
Last Name:HORNICK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 CHAPEL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6958
Mailing Address - Country:US
Mailing Address - Phone:503-250-1052
Mailing Address - Fax:
Practice Address - Street 1:150 SARGENT DR STE 2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6100
Practice Address - Country:US
Practice Address - Phone:203-503-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68645207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology