Provider Demographics
NPI:1811941867
Name:MARK NOVICK MD PC
Entity type:Organization
Organization Name:MARK NOVICK MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-6000
Mailing Address - Street 1:450 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1902
Mailing Address - Country:US
Mailing Address - Phone:718-375-6000
Mailing Address - Fax:718-375-6576
Practice Address - Street 1:450 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1902
Practice Address - Country:US
Practice Address - Phone:718-375-6000
Practice Address - Fax:718-375-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2289274Medicaid
NY2289274Medicaid