Provider Demographics
NPI:1043203474
Name:WITKOWSKA, RENATA ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:RENATA
Middle Name:ANN
Last Name:WITKOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5243
Mailing Address - Country:US
Mailing Address - Phone:845-563-9990
Mailing Address - Fax:845-563-9992
Practice Address - Street 1:200 LAKE ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5243
Practice Address - Country:US
Practice Address - Phone:845-563-9990
Practice Address - Fax:845-563-9992
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002081207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
331832OtherMEDICARE
NY00472931Medicaid
NYI50655Medicare UPIN