MEDICARE: RENEW MEDICAL OF NEW YORK, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	207Q00000X	Family Medicine Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1356979447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW MEDICAL OF NEW YORK, PLLC

Provider Business Mailing Address
First Line	:	1481 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4667
Country	:	US
Telephone Number	:	929-491-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7202 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1906
Country	:	US
Telephone Number	:	929-491-7700
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	REKHA BHANDARI
Credential	:	M.D.
Telephone Number	:	516-587-0804

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	05/12/2023

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