=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710013891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZOYA REZNIK DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 12/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 EXCHANGE PL SUITE 1414
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10005-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-425-1060
-----------------------------------------------------
Fax | 212-480-0108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 EXCHANGE PL SUITE 1414
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10005-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-425-1060
-----------------------------------------------------
Fax | 212-480-0108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 17142
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 62 028687
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------