Healthcare Provider Details

I. General information

NPI: 1952223240
Provider Name (Legal Business Name): ATLANTIC CITY RENAISSANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 ATLANTIC AVE
ATLANTIC CITY NJ
08401-6914
US

IV. Provider business mailing address

1637 ATLANTIC AVE
ATLANTIC CITY NJ
08401-6914
US

V. Phone/Fax

Practice location:
  • Phone: 856-264-1877
  • Fax:
Mailing address:
  • Phone: 856-264-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ROBERT COGOSSI
Title or Position: TREASURER
Credential: BSN
Phone: 856-264-1877