Active NPI
Concetta Marie Renkun, M.D.
- Pediatrics Physician
- Longport, NJ
National Provider Identifier
1578736823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA02161000
- Practice address
- 32 N 32ND Ave
Longport, NJ 08403-1524 - Phone
- (609) 823-3240
- NPI assigned
- Apr 8, 2008
- Last updated
- Apr 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA02161000 | NJ | Primary |
Addresses
Primary practice location
32 N 32ND Ave
Longport, NJ 08403-1524
Mailing address
PO Box 458
Longport, NJ 08403-0458
Phone (609) 823-3240
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA02161000 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1578736823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 458",
"city": "LONGPORT",
"state": "NJ",
"postal_code": "084030458",
"telephone_number": "609-823-3240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 N 32ND AVE",
"city": "LONGPORT",
"state": "NJ",
"postal_code": "084031524",
"telephone_number": "609-823-3240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENKUN",
"first_name": "CONCETTA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-08",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA02161000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longport, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.