Healthcare Provider Details

I. General information

NPI: 1760428494
Provider Name (Legal Business Name): VINCENT A RENZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/17/2018
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

1 FEDERAL ST # 100
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-234-2828
  • Fax: 856-235-8931
Mailing address:
  • Phone: 856-356-4924
  • Fax: 856-356-4793

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 NumberMD041344L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06585000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: