Provider Demographics
NPI:1063416683
Name:RESNICK, LONNIE NEIL IX (DPM)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:NEIL
Last Name:RESNICK
Suffix:IX
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 EAST AVE
Mailing Address - Street 2:STE 313
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4902
Mailing Address - Country:US
Mailing Address - Phone:203-853-6570
Mailing Address - Fax:203-853-2078
Practice Address - Street 1:83 EAST AVE
Practice Address - Street 2:STE 313
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4902
Practice Address - Country:US
Practice Address - Phone:203-853-6570
Practice Address - Fax:203-853-2078
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2008-03-14
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CTCT000515213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030000515CT04OtherANTHEM BC-BS
CT004095205Medicaid
CTOV0227OtherHEALTHNET
CTZS274OtherOXFORD
CT030000515CT04OtherANTHEM BC-BS
CT0735440001Medicare NSC
CTT90689Medicare UPIN