Healthcare Provider Details

I. General information

NPI: 1629220108
Provider Name (Legal Business Name): PROJECT RENEWAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 E 3RD ST
NEW YORK NY
10003-8908
US

IV. Provider business mailing address

200 VARICK ST
NEW YORK NY
10014-4810
US

V. Phone/Fax

Practice location:
  • Phone: 212-620-0340
  • Fax: 212-633-1410
Mailing address:
  • Phone: 212-620-0340
  • Fax: 212-633-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number7002161R
License Number StateNY

VIII. Authorized Official

Name: LECK DZIE
Title or Position: DATABASE ADMINISTRATOR
Credential:
Phone: 212-620-0340