MEDICARE: NELSON LEE NOVICK 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	207N00000X	Dermatology Physician	1279411	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649383142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON LEE NOVICK MD

Provider Business Mailing Address
First Line	:	328 E 75TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3317
Country	:	US
Telephone Number	:	212-772-9300
Fax Number	:	212-772-0524

Provider Business Practice Location Address
First Line	:	328 E 75TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3317
Country	:	US
Telephone Number	:	212-772-9300
Fax Number	:	212-772-0524

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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