Healthcare Provider Details

I. General information

NPI: 1679156111
Provider Name (Legal Business Name): EUGENE REZNIK PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 MERCHANT DR
ALGONQUIN IL
60102-5917
US

IV. Provider business mailing address

1451 MERCHANT DR
ALGONQUIN IL
60102-5917
US

V. Phone/Fax

Practice location:
  • Phone: 847-469-7537
  • Fax: 847-469-7540
Mailing address:
  • Phone: 847-469-7537
  • Fax: 847-469-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071.022723
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001486
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: