MEDICARE: MS. RENEE MASON FNP-C

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	363LF0000X	Family Nurse Practitioner	26NJ00673100	NJ

General Provider Information

NPI Number	:	1508315581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE MASON FNP-C

Provider Business Mailing Address
First Line	:	2441 HIGHWAY 33
Second Line	:	SUITE A
City	:	NEPTUNE
State	:	NJ
Zip	:	07753
Country	:	US
Telephone Number	:	201-315-8937
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 CENTRAL AVE
Second Line	:	APT D2
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3057
Country	:	US
Telephone Number	:	201-315-8937
Fax Number	:

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

Provider Enumeration Date	:	10/01/2016
Last Update Date	:	02/01/2023

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