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General NPI Number Information
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NPI Number | 1144398173
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Entity Type | Organization
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Legal Business Name | LOUIS REZNICK DO PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6451 CENTRAL AVENUE
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City | GLENDALE
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State | NY
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Zip | 11385-6258
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Country | US
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Telephone | 718-821-4424
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Fax | 718-456-1747
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Provider Business Mailing Address
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Address Line | 6451 CENTRAL AVENUE
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City | GLENDALE
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State | NY
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Zip | 11385-6258
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Country | US
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Telephone | 718-821-4424
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Fax | 718-456-1747
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOUIS REZNICK
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Credential | DO
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Telephone | 718-821-4424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 109161
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 109161
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License Number State | NY
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