Provider Demographics
NPI:1093105348
Name:ADVANCED WOUND SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED WOUND SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTEROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-921-3772
Mailing Address - Street 1:3724 24TH ST
Mailing Address - Street 2:SUITE 242
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3553
Mailing Address - Country:US
Mailing Address - Phone:718-606-2590
Mailing Address - Fax:718-606-6087
Practice Address - Street 1:3724 24TH ST
Practice Address - Street 2:SUITE 242
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3553
Practice Address - Country:US
Practice Address - Phone:718-606-2590
Practice Address - Fax:718-606-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2013968332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies