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General NPI Number Information
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NPI Number | 1083677918
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Entity Type | Individual
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Provider Name | RENEE M LANGSTAFF PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 401 YOUNG AVE STE 275
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3141
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Country | US
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Telephone | 856-291-8855
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Fax | 856-291-8844
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Provider Business Mailing Address
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Address Line | 200 TRENTON RD
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City | BROWNS MILLS
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State | NJ
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Zip | 08015-1705
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Country | US
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Telephone | 609-893-6611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00039600
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License Number State | NJ
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