Provider Demographics
NPI:1861496200
Name:RESNIKOFF, LEONARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:B
Last Name:RESNIKOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-390-0040
Practice Address - Fax:732-390-1856
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA064030002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010294Medicaid
NY01740963Medicaid
NY01740963Medicaid
NJG42552Medicare UPIN