Provider Demographics
NPI:1316029671
Name:RENZIN, STEPHEN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:RENZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2071 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3701
Mailing Address - Country:US
Mailing Address - Phone:914-833-1000
Mailing Address - Fax:914-833-4226
Practice Address - Street 1:1 MADISON AVE
Practice Address - Street 2:FL 2
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1929
Practice Address - Country:US
Practice Address - Phone:914-833-1000
Practice Address - Fax:914-833-4226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2017-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY117223207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY290761Medicare PIN
NYB12367Medicare UPIN
NYSR02907610Medicare PIN