Healthcare Provider Details

I. General information

NPI: 1760422000
Provider Name (Legal Business Name): RENA Y DZIKOWSKI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 N MAIN ST REFUAH HEALTH CENTER
SPRING VALLEY NY
10977-1960
US

IV. Provider business mailing address

728 N MAIN ST REFUAH HEALTH CENTER
SPRING VALLEY NY
10977-1960
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax: 845-354-4298
Mailing address:
  • Phone: 845-354-9300
  • Fax: 845-354-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: