Provider Demographics
NPI:1174215636
Name:REZNIK, ANDREW MICHAEL
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:REZNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6389
Mailing Address - Country:US
Mailing Address - Phone:908-421-6894
Mailing Address - Fax:
Practice Address - Street 1:950 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5018
Practice Address - Country:US
Practice Address - Phone:732-914-4721
Practice Address - Fax:732-914-4765
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00353300156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician