Healthcare Provider Details

I. General information

NPI: 1225175094
Provider Name (Legal Business Name): STEPHEN BARRY REZNICK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 6TH AVE
BROOKLYN NY
11215-2942
US

IV. Provider business mailing address

309 6TH AVE
BROOKLYN NY
11215-2942
US

V. Phone/Fax

Practice location:
  • Phone: 718-768-5946
  • Fax: 718-768-5946
Mailing address:
  • Phone: 718-768-5946
  • Fax: 718-768-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: