Provider Demographics
NPI:1124280102
Name:OSCAR A. NOVICK, M.D., P.C.
Entity type:Organization
Organization Name:OSCAR A. NOVICK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-825-7171
Mailing Address - Street 1:111 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4203
Mailing Address - Country:US
Mailing Address - Phone:847-825-7171
Mailing Address - Fax:
Practice Address - Street 1:111 S WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4203
Practice Address - Country:US
Practice Address - Phone:847-825-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040048207K00000X, 207RA0000X, 2080P0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1568461796OtherNPI
ILC41168Medicare UPIN
IL1568461796OtherNPI