Provider Demographics
NPI:1689728933
Name:RESNICK, GEORGE EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:RESNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4513
Mailing Address - Country:US
Mailing Address - Phone:516-364-6319
Mailing Address - Fax:516-364-6320
Practice Address - Street 1:237 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4513
Practice Address - Country:US
Practice Address - Phone:516-364-6319
Practice Address - Fax:516-364-6320
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006698111NN0400X
PADC004725L111NN0400X
NJ38MC00592400111NN0400X
CT000967111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXXW131Medicare ID - Type UnspecifiedGROUP
NYU44532Medicare UPIN
NYX6K98XX131Medicare ID - Type UnspecifiedINDIVIDUAL