Healthcare Provider Details

I. General information

NPI: 1346775889
Provider Name (Legal Business Name): RENAISSANCE MEDICAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 NOBLE ST
EAST MEADOW NY
11554-5007
US

IV. Provider business mailing address

894 BEDFORD AVE
BROOKLYN NY
11205-3913
US

V. Phone/Fax

Practice location:
  • Phone: 516-862-0200
  • Fax:
Mailing address:
  • Phone: 718-222-5999
  • Fax: 718-387-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236983
License Number StateNY

VIII. Authorized Official

Name: DR. TANESHA D LAWRENCE
Title or Position: CEO
Credential: MD
Phone: 917-346-0543