Individual
DR. DMITRY REZNIKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6433 99TH ST, MEDICAL OFFICE SUITE, REGO PARK, NY 11374-3522
(718) 275-3587
(718) 275-3587
Mailing address
6433 99TH ST, MEDICAL OFFICE SUITE, REGO PARK, NY 11374-3522
(718) 275-3587
(718) 275-3587
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
231092
NY
207R00000X
Internal Medicine Physician
34.009711
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054696
—
OH
05
—
02551522
—
NY
05
—
3810024787
—
WV
Enumeration date
10/24/2006
Last updated
01/17/2013
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