Provider Demographics
NPI:1407391782
Name:JEFFREY G RESNICK DPM PC
Entity Type:Organization
Organization Name:JEFFREY G RESNICK DPM PC
Other - Org Name:JEFFREY G RESNICK, DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-772-4115
Mailing Address - Street 1:233 AYER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1131
Mailing Address - Country:US
Mailing Address - Phone:978-772-4115
Mailing Address - Fax:978-772-5320
Practice Address - Street 1:233 AYER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1131
Practice Address - Country:US
Practice Address - Phone:978-772-4115
Practice Address - Fax:978-772-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1682213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty