MEDICARE: RESNIK INDUSTRIES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN 173433	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000135295	OTHER	OH	ANTHEM BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1194970855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESNIK INDUSTRIES INC.

Provider Business Mailing Address
First Line	:	2288 COVENTRY RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3547
Country	:	US
Telephone Number	:	216-932-4423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2288 COVENTRY RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3547
Country	:	US
Telephone Number	:	216-932-4423
Fax Number	:

Authorized Official
Title or Position	:	NURSE ANESTHETIST
Name	:	MR. MARTY RESNIK
Credential	:	CRNA
Telephone Number	:	216-932-4423

Provider Enumeration Date	:	11/22/2008
Last Update Date	:	11/22/2008

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