Provider Demographics
NPI:1801984661
Name:REZK MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:REZK MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANY
Authorized Official - Middle Name:SADEK
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-658-6585
Mailing Address - Street 1:227 MOHAWK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105
Mailing Address - Country:US
Mailing Address - Phone:724-657-0469
Mailing Address - Fax:724-658-6743
Practice Address - Street 1:1750 NEW BUTLER ROAD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101
Practice Address - Country:US
Practice Address - Phone:724-658-6585
Practice Address - Fax:724-658-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059077 L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
160574OtherUNISON
2133171OtherAETNA
263036OtherHEALTH AMERICA
1512284OtherGATEWAY
PA1011865810001Medicaid
1681251OtherHIGH MARK
9481OtherUPMC
1512284OtherGATEWAY
160574OtherUNISON