Healthcare Provider Details

I. General information

NPI: 1710001540
Provider Name (Legal Business Name): RENEE JOSKOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 2ND ST SW ROOM # B732
WASHINGTON DC
20593-0002
US

IV. Provider business mailing address

PO BOX 83024
GAITHERSBURG MD
20883-3024
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number040087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: