Healthcare Provider Details

I. General information

NPI: 1164614814
Provider Name (Legal Business Name): S. B. RESNICK, PH.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E READ ST
BALTIMORE MD
21202-2403
US

IV. Provider business mailing address

103 E READ ST
BALTIMORE MD
21202-2403
US

V. Phone/Fax

Practice location:
  • Phone: 410-234-0007
  • Fax:
Mailing address:
  • Phone: 410-234-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0176
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0176
License Number StateMD

VIII. Authorized Official

Name: DR. STEFFI BETH RESNICK
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 410-234-0007