Healthcare Provider Details

I. General information

NPI: 1154482263
Provider Name (Legal Business Name): RENAISSANCE HEALTH CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 125TH ST
NEW YORK NY
10027-4426
US

IV. Provider business mailing address

215 W 125TH ST
NEW YORK NY
10027-4426
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-6500
  • Fax: 212-316-1479
Mailing address:
  • Phone: 212-932-6500
  • Fax: 212-316-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number112967
License Number StateNY

VIII. Authorized Official

Name: ARTURO CAESAR
Title or Position: ASSOC MED DIRECTOR
Credential: M.D.
Phone: 212-932-6500