Healthcare Provider Details

I. General information

NPI: 1043203474
Provider Name (Legal Business Name): RENATA ANN WITKOWSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LAKE ST
NEWBURGH NY
12550-5243
US

IV. Provider business mailing address

200 LAKE ST
NEWBURGH NY
12550-5243
US

V. Phone/Fax

Practice location:
  • Phone: 845-563-9990
  • Fax: 845-563-9992
Mailing address:
  • Phone: 845-563-9990
  • Fax: 845-563-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number002081
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number002081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: