Healthcare Provider Details

I. General information

NPI: 1104147925
Provider Name (Legal Business Name): MAKHMOOD REZNIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

10 CRENSHAW CT
MARLBORO NJ
07746-2710
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3000
  • Fax:
Mailing address:
  • Phone: 732-761-3952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number258548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: