Provider Demographics
NPI:1417072893
Name:THE RENAISSANCE PROJECT INC.
Entity Type:Organization
Organization Name:THE RENAISSANCE PROJECT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-345-1312
Mailing Address - Street 1:250 CLEARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1315
Mailing Address - Country:US
Mailing Address - Phone:914-345-1312
Mailing Address - Fax:914-345-1318
Practice Address - Street 1:350 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4110
Practice Address - Country:US
Practice Address - Phone:914-235-8048
Practice Address - Fax:914-712-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110211069251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01302538Medicaid