Provider Demographics
NPI:1275582181
Name:EAST COAST WOUND CARE P C
Entity Type:Organization
Organization Name:EAST COAST WOUND CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:976 MCLEAN AVE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-6790
Practice Address - Street 1:976 MCLEAN AVE
Practice Address - Street 2:SUITE 387
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4105
Practice Address - Country:US
Practice Address - Phone:914-237-6797
Practice Address - Fax:914-237-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360569772OtherMEDICAID
FL277265500Medicaid
OK200216370AMedicaid
NJ0050431OtherMEDICAID
NJ080283Medicare PIN
TX00W113Medicare PIN
IL0360569772OtherMEDICAID
NYWET041Medicare PIN
SC8523Medicare PIN
TX00X246Medicare PIN
TX00X245Medicare PIN
OK200216370AMedicaid
FL55052XMedicare PIN
GAGRP7848Medicare PIN
TX00W114Medicare PIN
NJ0050431OtherMEDICAID
FL277265500Medicaid
TX00X247Medicare PIN
IL213528Medicare PIN
TN3734720Medicare PIN
FLK6749AMedicare PIN
TX00W112Medicare PIN