MEDICARE: RENAISSANCE FAMILY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	236983	NY

General Provider Information

NPI Number	:	1184946899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE FAMILY CARE

Provider Business Mailing Address
First Line	:	1704 NOBLE ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-5007
Country	:	US
Telephone Number	:	516-862-0200
Fax Number	:	718-387-6429

Provider Business Practice Location Address
First Line	:	1704 NOBLE ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-5007
Country	:	US
Telephone Number	:	516-862-0200
Fax Number	:	718-387-6429

Authorized Official
Title or Position	:	OWNER
Name	:	TANESHA LAWRENCE
Credential	:	MD
Telephone Number	:	917-346-0543

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	12/27/2022

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