Healthcare Provider Details

I. General information

NPI: 1154477479
Provider Name (Legal Business Name): RICHARD A RENZA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 NEW JERSEY AVE
WILDWOOD CREST NJ
08260-1216
US

IV. Provider business mailing address

PO BOX 278
CAPE MAY COURT HOUSE NJ
08210-0278
US

V. Phone/Fax

Practice location:
  • Phone: 609-523-1331
  • Fax: 609-522-1516
Mailing address:
  • Phone: 609-523-1331
  • Fax: 609-522-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB02591800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: