Healthcare Provider Details

I. General information

NPI: 1487683272
Provider Name (Legal Business Name): RENZI MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W RITNER ST
PHILADELPHIA PA
19148-3535
US

IV. Provider business mailing address

1324 W RITNER ST
PHILADELPHIA PA
19148-3535
US

V. Phone/Fax

Practice location:
  • Phone: 267-773-7311
  • Fax:
Mailing address:
  • Phone: 267-773-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE CAPOZIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-339-4701