Provider Demographics
NPI:1629220108
Name:PROJECT RENEWAL INC
Entity Type:Organization
Organization Name:PROJECT RENEWAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATABASE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LECK
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-620-0340
Mailing Address - Street 1:200 VARICK ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4810
Mailing Address - Country:US
Mailing Address - Phone:212-620-0340
Mailing Address - Fax:212-633-1410
Practice Address - Street 1:8 E 3RD ST
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:212-620-0340
Practice Address - Fax:212-633-1410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT RENEWAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002161R261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01921402Medicaid
NYA300029908Medicare PIN