NPIMap

Organization Active NPI

Project Renewal Inc

  • Federally Qualified Health Center (FQHC)
  • New York, NY
National Provider Identifier
1720520083
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7002161R Issued in NY
Legal business name
PROJECT RENEWAL INC
Practice address
651 W 168TH St
New York, NY 10032-3703
Phone
(212) 740-1780
NPI assigned
Nov 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Mr. Mitchell Netburn
Title
President and Ceo
Phone
(212) 620-0340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7002161R NY Primary

Addresses

Primary practice location

651 W 168TH St
New York, NY 10032-3703

Mailing address

200 Varick St
9TH Floor
New York, NY 10014-4810
Phone (212) 620-0340

Other identifiers 1

IdentifierTypeStateIssuer
01921402MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140110000778 NY Part A Provider - Federally Qualified Health Center (FQHC) 6901798651 1 other NPI on this enrollment
Practice locations: New York, NY

Federally qualified health center certification: CCN 331102

Legal name
PROJECT RENEWAL INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 12, 2014
Last certification
Feb 12, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1967 in NY
Enrollment address
651 W. 168Thstreet
New York, NY 10032-4810

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Project Renewal Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 Varick St
#9
New York, NY 10014
Phone (212) 620-0340

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Colleen Cavanaugh Individual OtherBoard Member Jan 1, 2014
Laura J Rothschild Individual OtherBoard Member Jan 1, 2014
Steven Jones Individual Corporate OfficerCfo & Chief Administrative Offic Nov 15, 2013 10%
W-2 Managing EmployeeCfo & Cao Feb 10, 2003 10%
Project Renewal Fund, Inc Organization, New York, NY Non-profit 5% Or Greater Direct Ownership Interest Feb 13, 2001 100%
Operational/Managerial Control Nov 15, 2013 100%
Jules M Ranz Individual OtherBoard Member Jan 1, 2014
Pamela Bell Individual OtherBoard Member Jan 1, 2014
Geoff Proulx Individual OtherBoard Member Jan 1, 2014
Nan Perell Individual OtherBoard Member Jan 1, 2014
Neil S Mitchell Individual OtherBoard Member Jan 1, 2014
Mitchell Netburn Individual Corporate OfficerPresident & Ceo Nov 15, 2013 90%
W-2 Managing EmployeeCeo Aug 10, 2010 90%

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1720520083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 VARICK ST",
            "address_2": "9TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100144810",
            "telephone_number": "212-620-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323703",
            "telephone_number": "212-740-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROJECT RENEWAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-17",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "NETBURN",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "212-620-0340",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7002161R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01921402",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.