Active NPI
Jonathan Renelle, MS, ATC
- Athletic Trainer
- Clark, NJ
National Provider Identifier
1053589093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00140600
- Practice address
- 365 Westfield Ave
Clark, NJ 07066-1706 - Phone
- (732) 382-0910
- NPI assigned
- Feb 12, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00140600 | NJ | Primary |
Addresses
Primary practice location
365 Westfield Ave
Clark, NJ 07066-1706
Mailing address
667 Yetman Ave
Staten Island, NY 10307-1850
Phone (718) 356-9354
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00140600 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202774400000",
"number": "1053589093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "667 YETMAN AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103071850",
"telephone_number": "718-356-9354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "365 WESTFIELD AVE",
"city": "CLARK",
"state": "NJ",
"postal_code": "070661706",
"telephone_number": "732-382-0910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENELLE",
"first_name": "JONATHAN",
"name_prefix": "Mr.",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-12",
"last_updated": "2008-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00140600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.