NPIMap

Organization Active NPI

New York City Health and Hospitals Corporation

Doing business as Renaissance Diagnostic & Treatment Center

  • Clinic/Center
  • New York, NY
National Provider Identifier
1235147497
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Doing business as
Renaissance Diagnostic & Treatment Center
Practice address
264 W 118TH St
New York, NY 10026-1620
Phone
(212) 939-2304
NPI assigned
Aug 4, 2006
Last updated
Apr 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Min Than
Title
Sr. Director
Phone
(212) 442-3854

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Institutional Pharmacy 3336I0012X NU

Addresses

Primary practice location

264 W 118TH St
New York, NY 10026-1620

Mailing address

160 Water St FL 13
New York, NY 10038-4922
Phone (212) 442-3854

Other identifiers 1

IdentifierTypeStateIssuer
01210402MedicaidNY

Other names 1

  • Renaissance Diagnostic & Treatment Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040322001521 NY Part B Supplier - Clinic/Group Practice 4183535305 Receives reassigned benefits from 1,798 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20150915002824 NY Part A Provider - Federally Qualified Health Center (FQHC) 4082800305 Practice locations: New York, NY
O20160719000043 NY Part A Provider - Federally Qualified Health Center (FQHC) 4082800305 Practice locations: New York, NY
O20160824001572 NY Part A Provider - Federally Qualified Health Center (FQHC) 4082800305 Practice locations: New York, NY

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1235147497. Details of each certification follow.

Federally qualified health center certification: CCN 331161

Legal name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Doing business as
RENAISSANCE HEALTH CARE NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 15, 2015
Last certification
Sep 15, 2015
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1970 in NY
Enrollment address
264 W 118TH St
New York, NY 10026-1620

Federally qualified health center certification: CCN 571032

Legal name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Doing business as
ST. NICHOLAS HOUSES CHILD HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2016
Last certification
Oct 4, 2016
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1970 in NY
Enrollment address
281 W 127TH St
New York, NY 10027-2903

Federally qualified health center certification: CCN 571014

Legal name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Doing business as
LA CLINICA DE LAS AMERICAS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2016
Last certification
Oct 4, 2016
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1970 in NY
Enrollment address
175 Nagle Ave
New York, NY 10034-6001

Other NPIs with the same Medicare PAC ID 20

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 20

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1038410Renaissance Health Care Network - Sydenham Div264 W 118TH Street, New York, NY 10026Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 43

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Barbara a Lowe Individual Corporate DirectorBoard Member May 18, 2015
Vincent Calamia Individual Corporate DirectorBoard Member Jan 13, 2012
Gary Jenkins Individual Corporate DirectorBoard Member Mar 1, 2022
John E Ulberg Individual Corporate DirectorSr VP Jun 21, 2018
Corporate DirectorCfo Dec 19, 2018
Marjory J Karlin Individual Corporate DirectorChief Revenue Officer Aug 1, 2024
Operational/Managerial ControlChief Revenue Officer Aug 1, 2024
Anne Williams-Isom Individual Corporate DirectorBoard Member Mar 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
Anita Kawatra Individual Corporate DirectorBoard Member Jan 1, 2019
New York City Health and Hospitals Corporation Organization, New York, NY Operational/Managerial Control Dec 1, 2017 100%
Patricia Marthone Individual Corporate DirectorBoard Member Mar 1, 2022
Corporate DirectorBoard Member Dec 20, 2021
Feniosky Pena-Mora Individual Corporate DirectorBoard Member Jan 1, 2019
Richard a Minott Individual Corporate DirectorSenior Director Jan 1, 2020
W-2 Managing EmployeeSenior Director, Revenue Adminis Dec 1, 2017
Corporate DirectorSenior Director, Revenue Adminis Dec 1, 2017
Corporate DirectorSenior Director, Revenue Cycle Serv Dec 1, 2017
Operational/Managerial ControlSenior Director, Revenue Cycle Serv Dec 1, 2017
Mitchell H Katz Individual Corporate DirectorBoard Member Jan 8, 2018
Jose Pagan Individual Corporate DirectorBoard Member Jan 1, 2019
Sally Hernandez-Pinero Individual Corporate DirectorBoard Member Jan 1, 2019
Ashwin Vasan Individual Corporate DirectorBoard Member Mar 1, 2022
Corporate DirectorBoard Member Mar 14, 2022
Freda Wang Individual Corporate DirectorBoard Member Jan 1, 2019
Walid Michelen Individual Corporate OfficerChief Executive Officer/Cmo Jan 28, 2015
W-2 Managing EmployeeChief Executive Officer/Cmo Jul 1, 2015
Operational/Managerial ControlChief Executive Officer/Cmo Jan 28, 2015
Michelle Morazan Individual Corporate DirectorBoard Member Jan 28, 2015
Steven Banks Individual Corporate DirectorBoard Member Apr 1, 2014
Herman Smith Individual Corporate DirectorBoard Member Jan 28, 2015
Mary T Bassett Individual Corporate DirectorBoard Member Feb 14, 2014
John Rabbia Individual Corporate DirectorBoard Member Jan 28, 2015
Emily a Youssouf Individual Corporate DirectorBoard Member Nov 1, 2006
Ollie Worthy Individual Corporate OfficerChief Financial Officer Feb 28, 2015
W-2 Managing EmployeeChief Financial Officer Jul 1, 2015
Operational/Managerial ControlChief Financial Officer Feb 28, 2015
Anita Lee Individual Corporate OfficerChief Operating Officer Feb 28, 2015
W-2 Managing EmployeeChief Operating Officer Jul 1, 2015
Operational/Managerial ControlChief Operating Officer Feb 28, 2015
Hermina Palacio Individual Corporate DirectorBoard Member Jan 25, 2016
Lilliam Paoli Individual Corporate DirectorChair of the Board Oct 1, 2015
New York City Health and Hospitals Corporation Organization, New York, NY Corporation, Non-profit Operational/Managerial Control Mar 31, 2014 100%
Operational/Managerial Control Nov 1, 2006 100%
Moises Perez Individual Corporate DirectorBoard Member Jan 28, 2015
Michelle Lewis Individual W-2 Managing Employee Jul 1, 2015
Antoinette Brown Individual Corporate DirectorBoard Member Jan 28, 2015
Helen Arteaga Landaverde Individual Corporate DirectorBoard Member Jan 29, 2016
Denisha Johnson-Williams Individual Corporate DirectorBoard Member Jan 28, 2015
Vivian Bright Individual Corporate DirectorBoard Member Jan 28, 2015
Ramanathan Raju Individual Corporate OfficerPresident Mar 31, 2014
W-2 Managing EmployeePresident Jul 1, 2015
Operational/Managerial ControlPresident Mar 31, 2014
Elissa Macklin Individual Corporate DirectorBoard Member Jan 28, 2015
Anna Lee Individual Corporate DirectorBoard Member Jan 28, 2015
Shena Elrington Individual Corporate DirectorBoard Member Jan 28, 2015
Mark N Page Individual Corporate DirectorBoard Member Dec 20, 2013
Gary S Belkin Individual Corporate DirectorBoard Member Aug 25, 2014
Gordon J Campbell Individual Corporate DirectorVice Chair of the Board Apr 9, 2015
Melville E Boufford Individual Corporate DirectorBoard Member Nov 16, 2011
Christopher W Goetz Individual W-2 Managing EmployeeSenior Consultant/Mis, Revenue a Jan 1, 2018

Owners & managing parties with NPI records 34

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 34

All facility ownership & control disclosures 22

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Queens Hospital CenterJamaica, NY, CCN 33S231 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Elmhurst Hospital CenterElmhurst, NY, CCN 330128 Hospital Operational/Managerial Control Jan 1, 2011
Kings County Hospital CenterBrooklyn, NY, CCN 330202 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Metropolitan Hospital CenterNew York, NY, CCN 330199 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Metropolitan Hospital CenterNew York, NY, CCN 33S199 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2011
Metropolitan Hospital CenterNew York, NY, CCN 33T199 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Woodhull Medical & Mental Health CenterBrooklyn, NY, CCN 330396 Hospital Operational/Managerial Control (100%) Dec 1, 2017
Harlem Hospital CenterNew York, NY, CCN 33S240 Hospital Operational/Managerial Control (100%) Mar 10, 2017
Coler Rehabilitation and Nursing Care CenterRoosevelt Island, NY, CCN 335063 Skilled nursing facility Operational/Managerial Control (100%) Mar 31, 2014
Crown HeightsBrooklyn, NY, CCN 571023 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Brownsville Child Health ClinicBrooklyn, NY, CCN 571036 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Roberto Clemente Family Guidance CenterNew York, NY, CCN 571021 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Judson Health CenterNew York, NY, CCN 571031 Federally qualified health center Operational/Managerial Control (100%) Mar 31, 2014
Williamsburg Community Health CenterBrooklyn, NY, CCN 571094 Federally qualified health center Operational/Managerial Control (100%) Feb 10, 2018
Health Center at GunhillBronx, NY, CCN 571108 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2017
Greenpoint Community Health CenterBrooklyn, NY, CCN 571109 Federally qualified health center Operational/Managerial Control (100%) Feb 10, 2018
Vanderbilt Avenue Health CenterStaten Island, NY, CCN 571172 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
South Queens Community CenterJamaica, NY, CCN 571161 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Parsons Community Health CenterJamaica, NY, CCN 571173 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Woodside Houses Child Health CenterWoodside, NY, CCN 571170 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Corona District Health CenterCorona, NY, CCN 571168 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2018
Women's Medical Center at CoronaCorona, NY, CCN 571165 Federally qualified health center Operational/Managerial Control Jul 1, 2018

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Practitioners & affiliated clinicians

Practitioners 110

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 110

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743465600000",
    "number": "1235147497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 WATER ST FL 13",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384922",
            "telephone_number": "212-442-3854",
            "fax_number": "212-442-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 W 118TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100261620",
            "telephone_number": "212-939-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK CITY HEALTH AND HOSPITALS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A",
        "authorized_official_last_name": "THAN",
        "authorized_official_first_name": "MIN",
        "authorized_official_title_or_position": "SR. DIRECTOR",
        "authorized_official_telephone_number": "212-442-3854"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01210402",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Diagnostic & Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renaissance Diagnostic & Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.