Provider Demographics
NPI:1578736823
Name:RENKUN, CONCETTA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CONCETTA
Middle Name:MARIE
Last Name:RENKUN
Suffix:
Gender:F
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:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:LONGPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08403-0458
Mailing Address - Country:US
Mailing Address - Phone:609-823-3240
Mailing Address - Fax:
Practice Address - Street 1:32 N 32ND AVE
Practice Address - Street 2:
Practice Address - City:LONGPORT
Practice Address - State:NJ
Practice Address - Zip Code:08403-1524
Practice Address - Country:US
Practice Address - Phone:609-823-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02161000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics