Healthcare Provider Details

I. General information

NPI: 1215039037
Provider Name (Legal Business Name): BRIAN ELKINS NOVICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11821 QUEENS BLVD STE 601
FOREST HILLS NY
11375-7206
US

IV. Provider business mailing address

11821 QUEENS BLVD STE 601
FOREST HILLS NY
11375-7206
US

V. Phone/Fax

Practice location:
  • Phone: 516-426-8604
  • Fax: 718-261-2285
Mailing address:
  • Phone: 516-426-8604
  • Fax: 718-261-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number140070
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number140070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: