MEDICARE: RENAISSANCE CDPAP 1, NY INC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1467956029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE CDPAP 1, NY INC

Provider Business Mailing Address
First Line	:	267 DOUGLASS ST FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2664
Country	:	US
Telephone Number	:	718-649-3670
Fax Number	:	908-378-3331

Provider Business Practice Location Address
First Line	:	267 DOUGLASS ST FL 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2664
Country	:	US
Telephone Number	:	718-649-3670
Fax Number	:	908-378-3331

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. ALEXANDER MARKOWITS
Credential	:
Telephone Number	:	732-582-0400

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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