Provider Demographics
NPI:1215167267
Name:REZNEK, DORIT (MAC)
Entity type:Individual
Prefix:
First Name:DORIT
Middle Name:
Last Name:REZNEK
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6811
Mailing Address - Country:US
Mailing Address - Phone:352-335-2332
Mailing Address - Fax:352-337-2535
Practice Address - Street 1:305 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6811
Practice Address - Country:US
Practice Address - Phone:352-335-2332
Practice Address - Fax:352-337-2535
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist