Healthcare Provider Details

I. General information

NPI: 1235315797
Provider Name (Legal Business Name): DAVID REZNIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 12/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CHAPEL AVE W SUITE 100
CHERRY HILL NJ
08002-2051
US

IV. Provider business mailing address

2250 CHAPEL AVE W SUITE 100
CHERRY HILL NJ
08002-2051
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-9000
  • Fax: 856-482-1159
Mailing address:
  • Phone: 856-482-9000
  • Fax: 856-482-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA08629300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: