Provider Demographics
NPI:1861995912
Name:RENICK, ERIKA (RD, CSOWM)
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:RENICK
Suffix:
Gender:F
Credentials:RD, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MASON AVENUE
Mailing Address - Street 2:BUILDING C - 3RD FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-1300
Mailing Address - Fax:
Practice Address - Street 1:256 MASON AVENUE
Practice Address - Street 2:BUILDING C - 3RD FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered