Provider Demographics
NPI:1669414280
Name:RESNICK, STACY A (DPM)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:RESNICK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-861-0854
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-997-5750
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004561R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017598980001Medicaid
PARE028591EGFMedicare ID - Type Unspecified