Provider Demographics
NPI:1851362891
Name:REZNIK, INGA (PHD)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:REZNIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W 24TH ST
Mailing Address - Street 2:10TH FLOOR, SUITE 1011
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3206
Mailing Address - Country:US
Mailing Address - Phone:212-929-4325
Mailing Address - Fax:
Practice Address - Street 1:49 W 24TH ST
Practice Address - Street 2:10TH FLOOR, SUITE 1011
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3206
Practice Address - Country:US
Practice Address - Phone:212-929-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VM6181Medicare ID - Type Unspecified
Q29536Medicare UPIN