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General NPI Number Information
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NPI Number | 1467028258
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Entity Type | Organization
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Legal Business Name | PROJECT RENEWAL
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 8 E 3RD ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10003-8908
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Country | US
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Telephone | 212-533-8400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1469
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City | BRONX
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State | NY
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Zip | 10451-1469
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Country | US
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Telephone | 646-544-8855
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. JONATHAN GIFTOS
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Credential | MD
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Telephone | 212-533-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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