Healthcare Provider Details

I. General information

NPI: 1144398173
Provider Name (Legal Business Name): LOUIS REZNICK DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 CENTRAL AVENUE
GLENDALE NY
11385-6258
US

IV. Provider business mailing address

6451 CENTRAL AVENUE
GLENDALE NY
11385-6258
US

V. Phone/Fax

Practice location:
  • Phone: 718-821-4424
  • Fax: 718-456-1747
Mailing address:
  • Phone: 718-821-4424
  • Fax: 718-456-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109161
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number109161
License Number StateNY

VIII. Authorized Official

Name: LOUIS REZNICK
Title or Position: PRESIDENT
Credential: DO
Phone: 718-821-4424