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General NPI Number Information
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NPI Number | 1356979447
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Entity Type | Organization
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Legal Business Name | RENEW MEDICAL OF NEW YORK, PLLC
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 7202 FORT HAMILTON PKWY
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City | BROOKLYN
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State | NY
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Zip | 11228-1906
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Country | US
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Telephone | 929-491-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 MCDONALD AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-4667
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Country | US
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Telephone | 929-491-7700
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | REKHA BHANDARI
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Credential | M.D.
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Telephone | 516-587-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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