Provider Demographics
NPI:1730360140
Name:CHARLES T RESNICK, M.D.,INC.
Entity type:Organization
Organization Name:CHARLES T RESNICK, M.D.,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-795-6426
Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-795-6426
Mailing Address - Fax:626-795-6422
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-795-6426
Practice Address - Fax:626-795-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37039207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37039OtherMEDICAL LICENSE
CAA46923Medicare UPIN
CAG37039OtherMEDICAL LICENSE