Provider Demographics
NPI:1063654085
Name:WOODS, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WOODS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E 92ND ST
Mailing Address - Street 2:APT 24E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6811
Mailing Address - Country:US
Mailing Address - Phone:917-743-8539
Mailing Address - Fax:
Practice Address - Street 1:408 E 92ND ST
Practice Address - Street 2:APT 24E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6811
Practice Address - Country:US
Practice Address - Phone:917-743-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67287246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist