1952399883 NPI number — RENEE KENDZIERSKI DO

Table of content: RENEE KENDZIERSKI DO (NPI 1952399883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952399883 NPI number — RENEE KENDZIERSKI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENDZIERSKI
Provider First Name:
RENEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952399883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 W HUNTING PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19129-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-707-7237
Provider Business Mailing Address Fax Number:
215-707-9389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-7237
Provider Business Practice Location Address Fax Number:
215-707-9389
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  OS010808L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A3738029 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1010761130001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60033560 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2851114000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7464884 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11439458 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: KE001978102 . This is a "HIGHMARK PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0040533 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396272 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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