Provider Demographics
NPI:1134302888
Name:RENSIMER, WAYNE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:THOMAS
Last Name:RENSIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:NJ
Mailing Address - Zip Code:08202-1245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6210 OCEAN DR
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:NJ
Practice Address - Zip Code:08202-1245
Practice Address - Country:US
Practice Address - Phone:609-368-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014330E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB33787Medicare UPIN