Healthcare Provider Details

I. General information

NPI: 1467758458
Provider Name (Legal Business Name): RENZI FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 N. CHURCH ST. STE. A
MOORESTOWN NJ
08057-1143
US

IV. Provider business mailing address

1217 N. CHURCH ST. STE. A
MOORESTOWN NJ
08057-1143
US

V. Phone/Fax

Practice location:
  • Phone: 856-234-2828
  • Fax: 256-235-8931
Mailing address:
  • Phone: 856-234-2828
  • Fax: 256-235-8931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06585000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0413441
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06585000
License Number StateNJ

VIII. Authorized Official

Name: DR. VINCENT ANTHONY RENZI
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 856-234-2828