Provider Demographics
NPI:1467758458
Name:RENZI FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:RENZI FAMILY MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-234-2828
Mailing Address - Street 1:1217 N. CHURCH ST.
Mailing Address - Street 2:STE. A
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1143
Mailing Address - Country:US
Mailing Address - Phone:856-234-2828
Mailing Address - Fax:256-235-8931
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:256-235-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06585000207Q00000X, 207R00000X
PAMD0413441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE83126Medicare PIN
NJ630525Medicare PIN