Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 160569 | NY |
NPI | 1194785550 |
---|---|
Provider Name | Dr. Richard Novitch |
First Address | Scarsdale, NY 10583-2114 |
Second Address | White Plains, NY 10605-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160569 | STATE LICENSE (01) | NY |
E17603 | (02) | NY |