MEDICARE: JOSEPH J RENZI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS005082L	PA

General Provider Information

NPI Number	:	1043255003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH J RENZI D.O.

Provider Business Mailing Address
First Line	:	1324 W RITNER ST
Second Line	:	GROUND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-3535
Country	:	US
Telephone Number	:	267-773-7311
Fax Number	:	267-773-7312

Provider Business Practice Location Address
First Line	:	1324 W RITNER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-3535
Country	:	US
Telephone Number	:	267-773-7311
Fax Number	:	267-773-7312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	10/11/2011

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