MEDICARE: ILANA S RESNICK MA

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1699342303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILANA S RESNICK MA

Provider Business Mailing Address
First Line	:	19 HIALEAH DR
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1252
Country	:	US
Telephone Number	:	732-675-1218
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 HIALEAH DR
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1252
Country	:	US
Telephone Number	:	732-675-1218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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Directions to “ ILANA S RESNICK MA” Practice Location

Language	Start Address	Practice Location

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