Healthcare Provider Details

I. General information

NPI: 1891844700
Provider Name (Legal Business Name): POOJA RENJEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

130 KINDERKAMACK RD STE. 200
RIVER EDGE NJ
07661-1939
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2200
  • Fax: 201-489-2812
Mailing address:
  • Phone: 201-488-2660
  • Fax: 201-489-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA08734400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0233862
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: