Healthcare Provider Details

I. General information

NPI: 1316093636
Provider Name (Legal Business Name): RICHARD A RENZA DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 08/22/2020
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 Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD ALLEN RENZA
Title or Position: PRESIDENT
Credential: DO
Phone: 609-523-1331