Provider Demographics
NPI:1538488820
Name:STEPHEN J RENZI MEDICAL PC
Entity Type:Organization
Organization Name:STEPHEN J RENZI MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RENZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-297-4555
Mailing Address - Street 1:160 S RAILROAD ST
Mailing Address - Street 2:STATION SQUARE
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1499
Mailing Address - Country:US
Mailing Address - Phone:570-297-4555
Mailing Address - Fax:570-297-4777
Practice Address - Street 1:160 S RAILROAD ST
Practice Address - Street 2:STATION SQUARE
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1499
Practice Address - Country:US
Practice Address - Phone:570-297-4555
Practice Address - Fax:570-297-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103130306-0001Medicaid
PA103130306-0001Medicaid
PA199006Medicare PIN