Healthcare Provider Details

I. General information

NPI: 1861825572
Provider Name (Legal Business Name): PROJECT RENEWAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
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

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

V. Phone/Fax

Practice location:
  • Phone: 212-533-8400
  • Fax:
Mailing address:
  • Phone: 212-533-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number160611600
License Number StateNY

VIII. Authorized Official

Name: MITCHELL NETBURN
Title or Position: CEO
Credential:
Phone: 212-620-0340