Basic Information
| Provider Information | |||||||||
| NPI: | 1497812796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESNICK | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 31-00 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074103963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017962255 | ||||||||
| FaxNumber: | 2017963711 | ||||||||
| Practice Location | |||||||||
| Address1: | 31-00 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074103963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017962255 | ||||||||
| FaxNumber: | 2017967020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 10/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MA072245 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1K6966 | 01 | NJ | HEALTHNET | OTHER | 8574600 | 05 | NJ | MEDICAID | BP273 | 01 | NJ | OXFORD HEALTH PLANS | OTHER |