Provider Demographics
NPI:1760428494
Name:RENZI, VINCENT A (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:RENZI
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 1:1 FEDERAL ST # 100
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-356-4793
Practice Address - Street 1:1217 N. CHURCH ST.
Practice Address - Street 2:STE A
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1143
Practice Address - Country:US
Practice Address - Phone:856-234-2828
Practice Address - Fax:856-235-8931
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06585000207Q00000X, 207R00000X
PAMD041344L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83126Medicare UPIN
630525Medicare PIN