Provider Demographics
NPI:1265715775
Name:ANDREA I. REZNIK MD PA
Entity type:Organization
Organization Name:ANDREA I. REZNIK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ISABELLE
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-725-4242
Mailing Address - Street 1:201 UNION AVE
Mailing Address - Street 2:BLDG. 2 SUITE A
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3002
Mailing Address - Country:US
Mailing Address - Phone:908-725-4242
Mailing Address - Fax:908-725-4006
Practice Address - Street 1:201 UNION AVE
Practice Address - Street 2:BLDG. 2 SUITE A
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3002
Practice Address - Country:US
Practice Address - Phone:908-725-4242
Practice Address - Fax:908-725-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04032600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3265307Medicaid
NJC53343Medicare UPIN
NJ116627Medicare PIN