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General NPI Number Information
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NPI Number | 1063538023
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Entity Type | Individual
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Provider Name | ELISE DEBORAH RESNICK D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 505 N MAIN ST STE C
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City | GREENVILLE
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State | SC
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Zip | 29601-2019
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Country | US
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Telephone | 864-232-2734
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Fax | 864-232-8126
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Provider Business Mailing Address
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Address Line | 31 STATION CT APT 307
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City | GREENVILLE
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State | SC
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Zip | 29601-2986
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Country | US
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Telephone | 310-916-7621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2OA7916
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 450
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License Number State | SC
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