=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548521701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESNIK MEDICAL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2012
-----------------------------------------------------
Last Update Date | 06/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 RESNIK RD
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-0754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 RESNIK RD
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-0754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC E JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 508-746-0754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------