Healthcare Provider Details

I. General information

NPI: 1235262999
Provider Name (Legal Business Name): BRIAN HOWARD NOVACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N CAMDEN DR SUITE 1010
BEVERLY HILLS CA
90210-4532
US

IV. Provider business mailing address

414 N CAMDEN DR
BEVERLY HILLS CA
90210-4532
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8818
  • Fax: 310-859-1865
Mailing address:
  • Phone: 310-888-8818
  • Fax: 310-859-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC40329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: