Provider Demographics
NPI:1104494392
Name:RENO, THERESA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:RENO
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:185 S ORANGE AVE # MSBH-538
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2757
Mailing Address - Country:US
Mailing Address - Phone:973-972-5252
Mailing Address - Fax:973-972-3144
Practice Address - Street 1:185 S ORANGE AVE # MSBH-538
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-5252
Practice Address - Fax:973-972-3144
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT222861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine