Provider Demographics
NPI:1851475776
Name:REZNIK, DMITRIY (PA)
Entity Type:Individual
Prefix:
First Name:DMITRIY
Middle Name:
Last Name:REZNIK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3031 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3205
Mailing Address - Country:US
Mailing Address - Phone:510-596-8125
Mailing Address - Fax:510-225-2745
Practice Address - Street 1:101 NE 3RD AVE STE 1500
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1181
Practice Address - Country:US
Practice Address - Phone:954-247-8790
Practice Address - Fax:877-594-6196
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA57357363A00000X
IL085.002843363A00000X
NY019136363A00000X
FLPA9117176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant