Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 140070 | NY |
N | 2080P0201X | Pediatric Allergist | 140070 | NY |
NPI | 1215039037 |
---|---|
Provider Name | Brian Elkins Novick |
First Address | Forest Hills, NY 11375-7206 |
Second Address | Forest Hills, NY 11375-7206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B11263 | (02) | NY |