Provider Demographics
NPI:1144398173
Name:LOUIS REZNICK DO PC
Entity Type:Organization
Organization Name:LOUIS REZNICK DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-821-4424
Mailing Address - Street 1:6451 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6258
Mailing Address - Country:US
Mailing Address - Phone:718-821-4424
Mailing Address - Fax:718-456-1747
Practice Address - Street 1:6451 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6258
Practice Address - Country:US
Practice Address - Phone:718-821-4424
Practice Address - Fax:718-456-1747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109161207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
109161OtherHEALTH PARTNERS
000293570101OtherHEALTH PLUS
176713OtherELDER PLAN
NY00241896Medicaid
08P087OtherNY PRESBYT COMM HLTH PLAN
592275OtherUNITED HEALTHCARE(COMM)
1000015505OtherAFFINITY HEALTH PLAN
119266OtherWELLCARE
44607OtherEMPIRE BCBS
0101193OtherUNITED HEALTHCARE (GOVT)
20280OtherAETNA
DP484OtherOXFORD HEALTH PLANS
DP484OtherOXFORD HEALTH PLANS
119266OtherWELLCARE
44607OtherEMPIRE BCBS