Provider Demographics
NPI:1841224847
Name:GIACCHI, RENATO J (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:J
Last Name:GIACCHI
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:PO BOX 3001
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0598
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:STE 105
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-644-0808
Practice Address - Fax:973-644-9270
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068878207Y00000X
NY1989031207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H17139Medicare UPIN
038351Medicare ID - Type Unspecified