Provider Demographics
NPI:1063780450
Name:NOVIKOV, IRINA (ANP)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:NOVIKOV
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 BRIGHTON 3RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7078
Mailing Address - Country:US
Mailing Address - Phone:718-975-4334
Mailing Address - Fax:718-975-4337
Practice Address - Street 1:70 W BRIGHTON AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:732-970-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305809363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health