Provider Demographics
NPI:1942467089
Name:REZNIK, MARK (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:REZNIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 AVENUE P
Mailing Address - Street 2:AVENUE P MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-259-6666
Mailing Address - Fax:718-259-7000
Practice Address - Street 1:209 AVENUE P
Practice Address - Street 2:AVENUE P MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-259-6666
Practice Address - Fax:718-259-7000
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY026417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA4000000280Medicare PIN