Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 099098 | NY |
NPI | 1558561985 |
---|---|
Provider Name | Jack Resnik |
First Address | Rochester, NY 14611 |
Second Address | Rochester, NY 14611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D01696 | (02) |