Provider Demographics
NPI:1083677918
Name:LANGSTAFF, RENEE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:M
Last Name:LANGSTAFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:VACANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-1705
Mailing Address - Country:US
Mailing Address - Phone:609-893-6611
Mailing Address - Fax:
Practice Address - Street 1:401 YOUNG AVE STE 275
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3141
Practice Address - Country:US
Practice Address - Phone:856-291-8855
Practice Address - Fax:856-291-8844
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00039600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026097Medicaid
NJ026097Medicaid
NJS77574Medicare UPIN