Provider Demographics
NPI:1487683272
Name:RENZI MEDICAL, PC
Entity Type:Organization
Organization Name:RENZI MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-339-4701
Mailing Address - Street 1:1324 W RITNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3535
Mailing Address - Country:US
Mailing Address - Phone:267-773-7311
Mailing Address - Fax:
Practice Address - Street 1:1324 W RITNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3535
Practice Address - Country:US
Practice Address - Phone:267-773-7311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty