Basic Information
| Provider Information | |||||||||
| NPI: | 1033166285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIENZO | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 ROUTE 66 | ||||||||
| Address2: | FL 3 | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328070877 | ||||||||
| FaxNumber: | 2017511680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 ROUTE 34 SOUTH | ||||||||
| Address2: | SUITE D | ||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329740404 | ||||||||
| FaxNumber: | 7324494271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 25MA04948300 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00906952 | 01 | RR MEDICARE | OTHER | 1475908 | 05 | NJ | MEDICAID |