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1801897756

NPI Code Detail

MEDICARE: RENAISSANCE MEDICAL GROUP, PA

MEDICARE: RENAISSANCE MEDICAL GROUP, PA

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	207R00000X	Internal Medicine Physician		NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	CG0998	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84519	OTHER	NJ	WELLCHOICE OF NJ
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	977755	OTHER	PA	FOCUS HEALTHCARE
4	G436485	OTHER	NJ	OXFORD
5	84519	OTHER	NY	EMPIRE BC BS OF NY
6	00426770001	OTHER	PA	AMERIHEALTH OF NJ

General Provider Information

NPI Number	:	1801897756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE MEDICAL GROUP, PA

Provider Business Mailing Address
First Line	:	66 W GILBERT ST
Second Line	:	2ND FLOOR
City	:	TINTON FALLS
State	:	NJ
Zip	:	07701-4918
Country	:	US
Telephone Number	:	732-212-0051
Fax Number	:	732-212-0713

Provider Business Practice Location Address
First Line	:	155 JEFFERSON ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-1706
Country	:	US
Telephone Number	:	973-344-5498
Fax Number	:	973-344-6686

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH JOHN CALABRO
Credential	:	DO
Telephone Number	:	732-212-0060

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/21/2022

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Directions to “RENAISSANCE MEDICAL GROUP, PA ” Practice Location

Language	Start Address	Practice Location

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