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General NPI Number Information
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NPI Number | 1346775889
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 1704 NOBLE ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-5007
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Country | US
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Telephone | 516-862-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 894 BEDFORD AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-3913
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Country | US
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Telephone | 718-222-5999
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Fax | 718-387-6429
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Authorized Official
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Title or Position | CEO
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Name | DR. TANESHA D LAWRENCE
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Credential | MD
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Telephone | 917-346-0543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 236983
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License Number State | NY
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