Provider Demographics
NPI:1457368995
Name:PROJECT RENEWAL
Entity Type:Organization
Organization Name:PROJECT RENEWAL
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 1:200 VARICK ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4810
Practice Address - Country:US
Practice Address - Phone:212-620-0340
Practice Address - Fax:212-633-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245267Medicaid