Provider Demographics
NPI:1720112790
Name:KATHLEEEN A NOVICK, M.A.,P.T.
Entity Type:Organization
Organization Name:KATHLEEEN A NOVICK, M.A.,P.T.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT
Authorized Official - Phone:631-691-5338
Mailing Address - Street 1:320 MERRICK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3440
Mailing Address - Country:US
Mailing Address - Phone:631-691-5338
Mailing Address - Fax:631-691-0723
Practice Address - Street 1:320 MERRICK RD STE 3
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3440
Practice Address - Country:US
Practice Address - Phone:631-691-5338
Practice Address - Fax:631-691-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPT002394261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy