Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 002081 | NY |
N | 207R00000X | Internist | 002081 | NY |
N | 111NI0900X | Internist | 002081 | NY |
NPI | 1043203474 |
---|---|
Provider Name | Ms. Renata Ann Witkowska |
First Address | Newburgh, NY 12550-5243 |
Second Address | Newburgh, NY 12550-5243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 30/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00472931 | (05) | NY |
331832 | MEDICARE (01) | |
I50655 | (02) | NY |