Provider Demographics
NPI:1063538023
Name:RESNICK, ELISE DEBORAH (DO)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:DEBORAH
Last Name:RESNICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STATION CT APT 307
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2986
Mailing Address - Country:US
Mailing Address - Phone:310-916-7621
Mailing Address - Fax:
Practice Address - Street 1:505 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2019
Practice Address - Country:US
Practice Address - Phone:864-232-2734
Practice Address - Fax:864-232-8126
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA79162084P0800X
SC4502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry