Provider Demographics
NPI:1558327171
Name:RESNICK, SYBIL (MD)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 278
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-877-0977
Mailing Address - Fax:516-294-6861
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 278
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-877-0977
Practice Address - Fax:516-294-6861
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1739581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F49039Medicare UPIN
W2L252Medicare PIN
27H231Medicare ID - Type Unspecified