Provider Demographics
NPI:1477800464
Name:RESNICK, KIMBERLY D
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:RESNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:HANAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 LAURA LANE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-932-0979
Mailing Address - Fax:
Practice Address - Street 1:33 LAURA LN
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3108
Practice Address - Country:US
Practice Address - Phone:516-932-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator