Healthcare Provider Details

I. General information

NPI: 1063416683
Provider Name (Legal Business Name): LONNIE NEIL RESNICK IX DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date: 03/16/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

148 EAST AVE STE 1D
NORWALK CT
06851-5727
US

IV. Provider business mailing address

83 EAST AVE STE 313
NORWALK CT
06851-4902
US

V. Phone/Fax

Practice location:
  • Phone: 203-853-6570
  • Fax: 203-853-2078
Mailing address:
  • Phone: 203-853-6570
  • Fax: 203-853-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberCT000515
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: