Provider Demographics
NPI:1336210616
Name:RENNERT, RACHAEL (AUD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:
Last Name:RENNERT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8023
Mailing Address - Country:US
Mailing Address - Phone:732-818-3610
Mailing Address - Fax:732-818-3663
Practice Address - Street 1:250 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8023
Practice Address - Country:US
Practice Address - Phone:732-818-3610
Practice Address - Fax:732-818-3663
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA 00526231H00000X
NJMG 00920237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYA00526OtherAUDIOLOGIST LICENSE