Healthcare Provider Details

I. General information

NPI: 1982974440
Provider Name (Legal Business Name): PROJECT RENEWAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VARICK ST
NEW YORK NY
10014-4810
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-620-0340
  • Fax: 212-633-9044
Mailing address:
  • Phone: 212-533-8400
  • Fax: 212-777-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNY

VIII. Authorized Official

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