1386636058 NPI number — MICHAEL I RESNICK SR. MD

Table of content: MICHAEL I RESNICK SR. MD (NPI 1386636058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386636058 NPI number — MICHAEL I RESNICK SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RESNICK
Provider First Name:
MICHAEL
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386636058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
327 ROUTE 59
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIRMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-356-2900
Provider Business Mailing Address Fax Number:
845-356-7797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 ROUTE 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIRMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-356-2900
Provider Business Practice Location Address Fax Number:
845-356-7797
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  086369 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0014638 . This is a "AETNA HMO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 570F13 . This is a "EMPIRE BCBS (AIRMONT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 391733 . This is a "MVP (AIRMONT/STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 570F11 . This is a "EMPIRE BCBS (STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00133739 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 570F12 . This is a "EMPIRE BCBS (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0039141 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D0562 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 391734 . This is a "MVP (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RS358 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4413534 . This is a "AETNA PPO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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