Provider Demographics
NPI:1801150941
Name:ZINKOWSKI, DAWN LINDA
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LINDA
Last Name:ZINKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:LINDA
Other - Last Name:UNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2137 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6549
Mailing Address - Country:US
Mailing Address - Phone:631-467-7858
Mailing Address - Fax:
Practice Address - Street 1:2137 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779
Practice Address - Country:US
Practice Address - Phone:631-467-7858
Practice Address - Fax:631-467-7859
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist