Provider Demographics
NPI:1629247879
Name:DR. HARVEY RESNICK, ASSOC.
Entity Type:Organization
Organization Name:DR. HARVEY RESNICK, ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-297-0028
Mailing Address - Street 1:201 OAK DR SOUTH #107
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5626
Mailing Address - Country:US
Mailing Address - Phone:979-297-0028
Mailing Address - Fax:979-297-0504
Practice Address - Street 1:201 OAK DR SOUTH #107
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5626
Practice Address - Country:US
Practice Address - Phone:979-297-0028
Practice Address - Fax:979-297-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00834YMedicare PIN