Provider Demographics
NPI:1053480954
Name:RESNIKOFF, ADAM FARLEY (DPM)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:FARLEY
Last Name:RESNIKOFF
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 1:481 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6021
Mailing Address - Country:US
Mailing Address - Phone:212-679-3338
Mailing Address - Fax:
Practice Address - Street 1:481 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6021
Practice Address - Country:US
Practice Address - Phone:212-679-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004688213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0021318OtherGHI
NYP50912OtherBLUE CROSS BLUE SHIELD
NYP50912Medicare ID - Type Unspecified
NYU18037Medicare UPIN