Provider Demographics
NPI:1235147497
Name:NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Entity Type:Organization
Organization Name:NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Other - Org Name:RENAISSANCE DIAGNOSTIC & TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-442-3854
Mailing Address - Street 1:160 WATER ST FL 13
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-442-3854
Mailing Address - Fax:212-442-3870
Practice Address - Street 1:264 W 118TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1620
Practice Address - Country:US
Practice Address - Phone:212-939-2304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01210402Medicaid
W6C791Medicare ID - Type Unspecified