1306941729 NPI number — DONNAMARIE DZIKOWSKI LCSW

Table of content: DONNAMARIE DZIKOWSKI LCSW (NPI 1306941729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306941729 NPI number — DONNAMARIE DZIKOWSKI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DZIKOWSKI
Provider First Name:
DONNAMARIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306941729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDENHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11757-4732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-769-8453
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 202B
Provider Business Practice Location Address City Name:
AMITYVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11701-2780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-574-4606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R045761-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 248382000 . This is a "MAGELLAN PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 105473579 . This is a "UBH PROV#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7302084 . This is a "AETNA PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7480825 . This is a "GHI PIN#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 127510 . This is a "VYTRA PIN#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2471074 . This is a "OXFORD PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 164289 . This is a "VALUE OPTIONS PIN#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com