Provider Demographics
NPI:1063491215
Name:RESNIKOFF, FORREST (MD)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:
Last Name:RESNIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 AVE AT THE COMMON
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4803
Mailing Address - Country:US
Mailing Address - Phone:732-542-6300
Mailing Address - Fax:732-542-6392
Practice Address - Street 1:170 AVE AT THE COMMON
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4803
Practice Address - Country:US
Practice Address - Phone:732-542-6300
Practice Address - Fax:732-542-6392
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05082700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology