Provider Demographics
NPI:1811109143
Name:RESNICK, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:RESNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18319 CLIFFTOP WAY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5627
Mailing Address - Country:US
Mailing Address - Phone:917-972-0278
Mailing Address - Fax:
Practice Address - Street 1:105 NORFOLK STREET
Practice Address - Street 2:APARTMENT 11B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3314
Practice Address - Country:US
Practice Address - Phone:917-972-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA085317002085R0202X
RIMD128342085R0202X
PA4357862085R0202X
OH0926042085R0202X
KY421492085R0202X
WV232622085R0202X
IN01066297A2085R0202X
CA1547092085R0202X
NY2293912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology