MEDICARE: EITAN NOVOGRODSKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	315625	NY

General Provider Information

NPI Number	:	1649705864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EITAN NOVOGRODSKY MD

Provider Business Mailing Address
First Line	:	3225 FRANCIS LEWIS BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1922
Country	:	US
Telephone Number	:	718-670-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 FRANCIS LEWIS BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1922
Country	:	US
Telephone Number	:	718-670-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	06/09/2025

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