Provider Demographics
NPI:1982751913
Name:RESNIK DERMATOLOGY PA
Entity Type:Organization
Organization Name:RESNIK DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SORREL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RESNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-279-6060
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE B 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-279-6060
Mailing Address - Fax:305-279-6548
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE B 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-279-6060
Practice Address - Fax:305-279-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 9901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90991OtherBLUE CROSS BLUE SHIELD
FLD59453Medicare UPIN