Provider Demographics
NPI:1043375918
Name:WIX-HARRIS, RENATA ALMA (MD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:ALMA
Last Name:WIX-HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SLACK CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5775
Mailing Address - Country:US
Mailing Address - Phone:251-295-7840
Mailing Address - Fax:
Practice Address - Street 1:1924 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2031
Practice Address - Country:US
Practice Address - Phone:732-356-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09895500207Q00000X
AL27765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine