Provider Demographics
NPI:1821062712
Name:RESNICK, TREVOR HILTON (PT)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:HILTON
Last Name:RESNICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PENNINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977
Mailing Address - Country:US
Mailing Address - Phone:845-364-0499
Mailing Address - Fax:
Practice Address - Street 1:7610 -7612 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2411
Practice Address - Country:US
Practice Address - Phone:718-234-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014189-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014189-1OtherSTATE LICENCE NUMBER
NY014189-1OtherSTATE LICENCE NUMBER