Provider Demographics
NPI:1710087846
Name:REZNIK, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:REZNIK
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 1:470 GREENFIELD AVE STE 37
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3513
Mailing Address - Country:US
Mailing Address - Phone:559-589-9460
Mailing Address - Fax:559-589-9248
Practice Address - Street 1:470 GREENFIELD AVE STE 37
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3513
Practice Address - Country:US
Practice Address - Phone:559-589-9460
Practice Address - Fax:559-589-9248
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0407207RG0100X
CAA91193207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I41105Medicare UPIN