Provider Demographics
NPI:1740535111
Name:RESNICK, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 EAST 4TH STREET
Mailing Address - Street 2:APT 5P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4848
Mailing Address - Country:US
Mailing Address - Phone:917-519-8285
Mailing Address - Fax:
Practice Address - Street 1:2250 E 4TH ST
Practice Address - Street 2:APT 5P
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4848
Practice Address - Country:US
Practice Address - Phone:917-519-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682635297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist