Provider Demographics
NPI:1881608503
Name:RESNIK, MARTY D (CRNA)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:D
Last Name:RESNIK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN173433367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000516005OtherANTHEM
OH0583328OtherBCMH
OHP00949836OtherMEDICARE RAILROAD
OH415024OtherWELLCARE MEDICAID
OH7666926OtherAETNA
OH750957OtherBUCKEYE MEDICAID
OH000000221139OtherUNISON
OH430037552OtherRAILROAD MEDICARE
OH0683327Medicaid
OHRE8203125Medicare PIN
OH0683327Medicaid