Rahul Renjen, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

051708-1 Issued in NY

Practice address

103 White Park Rd
Ithaca, NY 14850-2258

Phone

(716) 523-1885

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1376677633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 PENFIELD RD",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145261736",
            "telephone_number": "585-432-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 WHITE PARK RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148502258",
            "telephone_number": "716-523-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENJEN",
        "first_name": "RAHUL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "051708-1",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "DS037113",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02898355",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020266440001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tevin Reid
• Hilary Reilly
• Yechiel A. Reit, MD
• Marilyn Carol Reitenbach, LMSW
• Anna Mae Remaneses, PT
• Fabiola Reyes, BCHHP
• Kyla Leann Reyes, LPN
• Alisa Ann Reynolds, LMSW
• Tamara Arleen Reynolds, RD
• Timothy Reynolds, DPT

• Orthodontics and Dentofacial Orthopedics Dentistry in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.