Provider Demographics
NPI:1467028258
Name:PROJECT RENEWAL
Entity Type:Organization
Organization Name:PROJECT RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-533-8400
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-1469
Mailing Address - Country:US
Mailing Address - Phone:646-544-8855
Mailing Address - Fax:
Practice Address - Street 1:8 E 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8908
Practice Address - Country:US
Practice Address - Phone:212-533-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility