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General NPI Number Information
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NPI Number | 1205288784
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Entity Type | Individual
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Provider Name | ALISA REZNIKOV MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 597 PARK AVE
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City | FREEHOLD
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State | NJ
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Zip | 07728-2590
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Country | US
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Telephone | 732-294-2540
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Fax | 732-409-2621
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Provider Business Mailing Address
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Address Line | 597 PARK AVE
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City | FREEHOLD
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State | NJ
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Zip | 07728-2590
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Country | US
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Telephone | 732-294-2540
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Fax | 732-409-2621
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 25MA10655500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA10655500
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License Number State | NJ
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