Provider Demographics
NPI:1043412828
Name:RESNICK, SCOTT (DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RESNICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 MADISON AVE
Mailing Address - Street 2:SUITE 1706
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8404
Mailing Address - Country:US
Mailing Address - Phone:212-421-9565
Mailing Address - Fax:
Practice Address - Street 1:654 MADISON AVE
Practice Address - Street 2:SUITE 1706
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8404
Practice Address - Country:US
Practice Address - Phone:212-421-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0404411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics