Individual ProviderGary ReznikInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address6333 Wilshire Blvd, #200, Los Angeles, CA 90048(323) 653-2504PECOS EnrollmentBased on the most recent information from CMS, provider Gary Reznik is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1043244296Provider TypeIndividualFull NameReznik, GaryTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date7/11/2006Last Updated7/22/2010Contact InformationPractice LocationPractice Address6333 Wilshire Blvd, #200, Los Angeles, CA 90048Phone(323) 653-2504Fax(323) 653-2505Mailing LocationMailing Address6333 Wilshire Blvd, #200, Los Angeles, CA 90048Phone(323) 653-2504Fax(323) 653-2515Provider TaxonomiesCodeDescriptionLicenseCode207RC0000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseG67314ACaliforniaProvider IdentifiersIDDescriptionIssuerID1215114251DescriptionMedicaidIssuerUnlistedCaliforniaIDWG67314FDescriptionOtherIssuerMEDICARE INDIVIDUAL PTANCaliforniaIDW21850DescriptionOtherIssuerMEDICARE GROUP PTANCalifornia