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General NPI Number Information
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NPI Number | 1780165100
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Entity Type | Organization
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Legal Business Name | RENEW MED SPA AND CLINIC LLC
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 601 HAMBURG TPKE STE 101
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City | WAYNE
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State | NJ
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Zip | 07470-2049
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Country | US
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Telephone | 973-942-4449
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Fax | 973-942-6339
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Provider Business Mailing Address
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Address Line | 3 BAKER ST
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City | WAYNE
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State | NJ
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Zip | 07470-4601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER M MATIER
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Credential | MD
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Telephone | 973-809-4186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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