Provider Demographics
NPI:1295794634
Name:NOVIK, LARRY E (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:NOVIK
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 1:325 REEF RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6537
Mailing Address - Country:US
Mailing Address - Phone:203-255-0215
Mailing Address - Fax:203-255-0046
Practice Address - Street 1:325 REEF RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6537
Practice Address - Country:US
Practice Address - Phone:203-255-0215
Practice Address - Fax:203-255-0046
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001243906Medicaid
CT001243906Medicaid
CT080001044Medicare ID - Type Unspecified