Provider Demographics
NPI:1952356123
Name:NOVICK, ANDREW S (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:NOVICK
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 1:579A CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:732-390-0040
Practice Address - Fax:732-390-1856
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050021002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0621803Medicaid
NJ300017321Medicare PIN
NJ594334Medicare PIN
NJ0621803Medicaid
NJ594334CQHMedicare PIN
NJ300022511Medicare PIN
E52527Medicare UPIN
NJ594334A2VMedicare PIN