Healthcare Provider Details

I. General information

NPI: 1043139652
Provider Name (Legal Business Name): PROJECT RENEWAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 W 59TH ST
NEW YORK NY
10023
US

IV. Provider business mailing address

200 VARICK ST FL 9
NEW YORK NY
10014-4810
US

V. Phone/Fax

Practice location:
  • Phone: 212-620-0340
  • Fax:
Mailing address:
  • Phone: 212-620-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERARD JOSEPH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 212-620-0340