Provider Demographics
NPI:1356979447
Name:RENEW MEDICAL OF NEW YORK, PLLC
Entity type:Organization
Organization Name:RENEW MEDICAL OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-587-0804
Mailing Address - Street 1:1481 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4667
Mailing Address - Country:US
Mailing Address - Phone:929-491-7700
Mailing Address - Fax:
Practice Address - Street 1:7202 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1906
Practice Address - Country:US
Practice Address - Phone:929-491-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty