Provider Demographics
NPI:1740606904
Name:REZNIK, JULLIYA
Entity Type:Individual
Prefix:
First Name:JULLIYA
Middle Name:
Last Name:REZNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 UNION TPKE APT 10A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8071
Mailing Address - Country:US
Mailing Address - Phone:917-838-5105
Mailing Address - Fax:
Practice Address - Street 1:9060 UNION TPKE APT 10A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-8071
Practice Address - Country:US
Practice Address - Phone:917-838-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist