Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1682 | MA |
N | 213ES0131X | Foot Surgery | 1682 | MA |
NPI | 1407822992 |
---|---|
Provider Name | Jeffrey G Resnick |
First Address | Harvard, MA 01451-1131 |
Second Address | Harvard, MA 01451-1131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 09/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001682 | TUFTS (01) | MA |
33636 | HARVARD PILGRIM (01) | MA |
3817 | FALLON (01) | MA |
T80741 | (02) | |
Y70741 | BLUE CROSS BLUE SHIELD (01) | MA |