Provider Demographics
NPI:1780644641
Name:REZNIK, ANDREA ISABELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ISABELLE
Last Name:REZNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 UNION AVE
Mailing Address - Street 2:BLDG 2 SUITE A
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-725-4242
Mailing Address - Fax:908-725-4006
Practice Address - Street 1:201 UNION AVE
Practice Address - Street 2:BLDG 2 SUITE A
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-725-4242
Practice Address - Fax:908-725-4006
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ403262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3265307Medicaid
222681346OtherTAX ID
NJ116627Medicare PIN
116627Medicare ID - Type Unspecified
222681346OtherTAX ID