Provider Demographics
NPI:1548308729
Name:TRENERY, RICHARD J (DPT CERT MDT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:TRENERY
Suffix:
Gender:M
Credentials:DPT CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1136
Mailing Address - Country:US
Mailing Address - Phone:908-730-6638
Mailing Address - Fax:908-725-9803
Practice Address - Street 1:1130 US HIGHWAY 202
Practice Address - Street 2:BUILDING E
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1490
Practice Address - Country:US
Practice Address - Phone:908-725-9595
Practice Address - Fax:908-725-9803
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA010232002251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100226Medicare ID - Type UnspecifiedMEDICARE ID