Healthcare Provider Details

I. General information

NPI: 1952404386
Provider Name (Legal Business Name): MARTIN RESNIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 COLLEGE PARKWAY STE 302
COLCHESTER VT
05446
US

IV. Provider business mailing address

P.O.BOX 5487
BURLINGTON VT
05402-5487
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-0019
  • Fax:
Mailing address:
  • Phone: 802-879-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number0000000000000000000
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number00000000000000000000
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: