Provider Demographics
NPI:1336176676
Name:NOVICK, MARNI LISA (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARNI
Middle Name:LISA
Last Name:NOVICK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DARDANELLI LN
Mailing Address - Street 2:STE. 22A
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-540-7128
Mailing Address - Fax:405-599-3013
Practice Address - Street 1:340 DARDANELLI LN
Practice Address - Street 2:SUITE 22A
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1418
Practice Address - Country:US
Practice Address - Phone:408-540-7128
Practice Address - Fax:408-599-3013
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2085231H00000X, 231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA119896OtherMEDICARE PTAN
CABV793YMedicare PIN
CAAU0002085Medicaid