Provider Demographics
NPI:1427459973
Name:RENZONI, DANIEL (RDN CDN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RENZONI
Suffix:
Gender:M
Credentials:RDN CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14136 72ND DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2313
Mailing Address - Country:US
Mailing Address - Phone:845-709-2430
Mailing Address - Fax:
Practice Address - Street 1:13773 70TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1925
Practice Address - Country:US
Practice Address - Phone:845-709-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86007861133V00000X
NY008437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered