MEDICARE: ERNST RENONDEAU APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR15639000	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ01208900	NJ

General Provider Information

NPI Number	:	1134714546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNST RENONDEAU APN

Provider Business Mailing Address
First Line	:	244 HENDRICKSON AVE
Second Line	:
City	:	EDGEWATER PARK
State	:	NJ
Zip	:	08010-2024
Country	:	US
Telephone Number	:	609-575-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 KILMER RD STE B
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2432
Country	:	US
Telephone Number	:	640-266-4033
Fax Number	:	225-254-3474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	03/26/2025

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