Provider Demographics
NPI:1659132686
Name:THE JEWISH RENAISSANCE FOUNDATION, INC.
Entity Type:Organization
Organization Name:THE JEWISH RENAISSANCE FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-324-2114
Mailing Address - Street 1:1090 KING GEORGES POST RD STE 704
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3722
Mailing Address - Country:US
Mailing Address - Phone:732-324-2114
Mailing Address - Fax:732-324-0256
Practice Address - Street 1:1931 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2072
Practice Address - Country:US
Practice Address - Phone:732-482-9600
Practice Address - Fax:732-372-0800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH RENAISSANCE FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)