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General NPI Number Information
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NPI Number | 1306415765
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Entity Type | Organization
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Legal Business Name | RENAISSANCE CARE LLC
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 55 DAVIDSON MILL RD
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-4751
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Country | US
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Telephone | 732-491-3619
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Fax |
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Provider Business Mailing Address
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Address Line | 55 DAVIDSON MILL RD
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-4751
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Country | US
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Telephone | 732-491-3619
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ALIYA FAYAZI
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Credential | APN
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Telephone | 732-491-3619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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