Individual
ALISA REZNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
597 PARK AVE, FREEHOLD, NJ 07728-2590
(732) 294-2540
(732) 409-2621
Mailing address
597 PARK AVE, FREEHOLD, NJ 07728-2590
(732) 294-2540
(732) 409-2621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA10655500
NJ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
25MA10655500
NJ
Other
Enumeration date
07/07/2016
Last updated
04/10/2024
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