Individual
MR. JONATHAN RENELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
365 WESTFIELD AVE, CLARK, NJ 07066-1706
(732) 382-0910
Mailing address
667 YETMAN AVE, STATEN ISLAND, NY 10307-1850
(718) 356-9354
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00140600
NJ
Other
Enumeration date
02/12/2008
Last updated
02/12/2008
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