Provider Demographics
NPI:1245245109
Name:ALBERTO, RENATO DECENA (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:DECENA
Last Name:ALBERTO
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 1:25 MULE RD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5035
Mailing Address - Country:US
Mailing Address - Phone:732-240-0404
Mailing Address - Fax:732-244-3555
Practice Address - Street 1:25 MULE RD
Practice Address - Street 2:BUILDING A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5035
Practice Address - Country:US
Practice Address - Phone:732-240-0404
Practice Address - Fax:732-244-3555
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03142800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
148982OtherMEDICARE GROUP
NJ2232308Medicaid
NJ2232308Medicaid
148982OtherMEDICARE GROUP