MEDICARE: MARK NOVICK MD PC

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		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	:	1811941867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK NOVICK MD PC

Provider Business Mailing Address
First Line	:	450 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1902
Country	:	US
Telephone Number	:	718-375-6000
Fax Number	:	718-375-6576

Provider Business Practice Location Address
First Line	:	450 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1902
Country	:	US
Telephone Number	:	718-375-6000
Fax Number	:	718-375-6576

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MARK D. NOVICK
Credential	:	M.D.
Telephone Number	:	718-375-6000

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/22/2020

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