Healthcare Provider Details

I. General information

NPI: 1528089950
Provider Name (Legal Business Name): NANCY J RENNERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

24 STEVENS ST
NORWALK CT
06850-3852
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2375
  • Fax: 203-852-2057
Mailing address:
  • Phone: 203-852-2375
  • Fax: 203-852-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number031031
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number031031
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number031031
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: