Provider Demographics
NPI:1407822992
Name:RESNICK, JEFFREY G (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:RESNICK
Suffix:
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 1:233 AYER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1131
Mailing Address - Country:US
Mailing Address - Phone:978-772-4115
Mailing Address - Fax:978-772-5320
Practice Address - Street 1:233 AYER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1131
Practice Address - Country:US
Practice Address - Phone:978-772-4115
Practice Address - Fax:978-772-5320
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1682213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3817OtherFALLON
MAY70741OtherBLUE CROSS BLUE SHIELD
MA001682OtherTUFTS
MA33636OtherHARVARD PILGRIM
MAY70741OtherBLUE CROSS BLUE SHIELD
MA33636OtherHARVARD PILGRIM