Provider Demographics
NPI:1164755773
Name:REZNIK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:REZNIK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-268-7478
Mailing Address - Street 1:2278 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5058
Mailing Address - Country:US
Mailing Address - Phone:347-268-7478
Mailing Address - Fax:
Practice Address - Street 1:40 W BRIGHTON AVE
Practice Address - Street 2:SUITE # 103/ ROOM 8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4901
Practice Address - Country:US
Practice Address - Phone:718-996-2260
Practice Address - Fax:718-996-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty