Active NPI
Thomas Reznik, M.D.
- Internal Medicine Physician
- Providence, RI
National Provider Identifier
1356661177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- LP01963
- Practice address
- 830 Chalkstone Ave
Providence, RI 02908-4734 - Phone
- (401) 273-7100
- Fax
- (401) 457-1426
- NPI assigned
- Jun 3, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | LP01963 | RI | Primary |
Addresses
Primary practice location
830 Chalkstone Ave
Providence, RI 02908-4734
Mailing address
830 Chalkstone Ave
Providence, RI 02908-4734
Phone (401) 273-7100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140328000063 | RI | Order and Referring Only - Internal Medicine | 6204067697 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP01963 | RI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1356661177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 CHALKSTONE AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029084734",
"telephone_number": "401-273-7100",
"fax_number": "401-457-1426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 CHALKSTONE AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029084734",
"telephone_number": "401-273-7100",
"fax_number": "401-457-1426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REZNIK",
"first_name": "THOMAS",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-03",
"last_updated": "2022-03-17",
"certification_date": "2022-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "RI",
"license": "LP01963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.