Provider Demographics
NPI:1871854646
Name:DZIKOWICZ, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DZIKOWICZ
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 1:109 JOANN WAY
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-8344
Mailing Address - Country:US
Mailing Address - Phone:518-842-8964
Mailing Address - Fax:
Practice Address - Street 1:109 JOANN WAY
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-8344
Practice Address - Country:US
Practice Address - Phone:518-842-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779712971252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency