Provider Demographics
NPI:1093389488
Name:TROTTER, RENEE (APN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:TROTTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MADISON ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6305
Mailing Address - Country:US
Mailing Address - Phone:201-739-9267
Mailing Address - Fax:
Practice Address - Street 1:DR. DOMONICK CONDO, MD
Practice Address - Street 2:622 BROADWAY
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-436-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01143300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine