Basic Information
| Provider Information | |||||||||
| NPI: | 1346561768 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST COAST WOUND CARE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 976 MCLEAN AVE | ||||||||
| Address2: | SUITE 387 | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107044105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376797 | ||||||||
| FaxNumber: | 9142376790 | ||||||||
| Practice Location | |||||||||
| Address1: | 976 MCLEAN AVE | ||||||||
| Address2: | SUITE 387 | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107044105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376797 | ||||||||
| FaxNumber: | 9142376790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | THEODOROU | ||||||||
| AuthorizedOfficialFirstName: | SPERO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SURGICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9142376797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.