Provider Demographics
NPI:1760797930
Name:WOUND CARE SPECIALIST OF NEW JERSEY
Entity Type:Organization
Organization Name:WOUND CARE SPECIALIST OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JANSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALINDONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-829-5301
Mailing Address - Street 1:824 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:188-796-5637
Practice Address - Street 1:824 KENNEDY BLVD.
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2212
Practice Address - Country:US
Practice Address - Phone:917-829-5301
Practice Address - Fax:888-796-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty