OrganizationGary Reznik M. D. IncInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address6333 Wilshire Blvd Ste 200, Los Angeles, CA 90048-5724(323) 653-2504PECOS EnrollmentBased on the most recent information from CMS, provider Gary Reznik M. D. Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1215114251Provider TypeOrganizationFull NameGary Reznik M. D. IncSubpartNoEnumeration Date1/22/2008Last Updated5/31/2012Contact InformationPractice LocationPractice Address6333 Wilshire Blvd Ste 200, Los Angeles, CA 90048-5724Phone(323) 653-2504Fax(323) 653-2515Mailing LocationMailing Address6333 Wilshire Blvd Ste 200, Los Angeles, CA 90048-5724Phone(323) 653-2504Fax(323) 653-2515Authorized OfficialNameReznik, Gary (President)Phone(323) 653-2504Provider TaxonomiesCodeDescriptionLicenseCode207RC0000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseG67314CaliforniaProvider IdentifiersIDDescriptionIssuerID1215114251DescriptionMedicaidIssuerUnlistedCaliforniaIDW21850DescriptionOtherIssuerMEDICARE GROUP PTANIDWG67314FDescriptionOtherIssuerMEDICARE INDIVIDUAL PTANCalifornia