Healthcare Provider Details

I. General information

NPI: 1386644128
Provider Name (Legal Business Name): RENEE GARRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 200N
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE SUITE 200N
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7701
  • Fax: 914-345-0653
Mailing address:
  • Phone: 914-493-7701
  • Fax: 914-345-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number140904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: