Provider Demographics
NPI:1689690786
Name:RESNIKOFF, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RESNIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MADISON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-540-9700
Mailing Address - Fax:973-540-9717
Practice Address - Street 1:131 MADISON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-540-9700
Practice Address - Fax:973-540-9717
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA058805002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7733500Medicaid
G55014Medicare UPIN
NJ7733500Medicaid