Provider Demographics
NPI:1558715193
Name:PODOLEC, RENATA
Entity Type:Individual
Prefix:MS
First Name:RENATA
Middle Name:
Last Name:PODOLEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MUNRO AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3418
Mailing Address - Country:US
Mailing Address - Phone:917-312-2146
Mailing Address - Fax:
Practice Address - Street 1:412 MUNRO AVE APT 2A
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3418
Practice Address - Country:US
Practice Address - Phone:917-312-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program