Provider Demographics
NPI:1194970855
Name:RESNIK INDUSTRIES INC.
Entity type:Organization
Organization Name:RESNIK INDUSTRIES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNIK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:216-932-4423
Mailing Address - Street 1:2288 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3547
Mailing Address - Country:US
Mailing Address - Phone:216-932-4423
Mailing Address - Fax:
Practice Address - Street 1:2288 COVENTRY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3547
Practice Address - Country:US
Practice Address - Phone:216-932-4423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-22
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 173433367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000135295OtherANTHEM BLUE CROSS BLUE SHIELD
OH=========002OtherMEDICAL MUTUAL
OHRE8203123Medicare PIN