Healthcare Provider Details

I. General information

NPI: 1659305522
Provider Name (Legal Business Name): STEVEN REZNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 W PALMETTO PARK RD SUITE 205
BOCA RATON FL
33433-3422
US

IV. Provider business mailing address

7280 W PALMETTO PARK RD SUITE 205
BOCA RATON FL
33433-3422
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-0191
  • Fax: 561-368-0151
Mailing address:
  • Phone: 561-368-0191
  • Fax: 561-368-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 30822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: