Provider Demographics
NPI:1023517968
Name:WOUNDTECH OF HAWAII, INC
Entity type:Organization
Organization Name:WOUNDTECH OF HAWAII, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-923-7440
Mailing Address - Street 1:200 S PARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8541
Mailing Address - Country:US
Mailing Address - Phone:954-923-7440
Mailing Address - Fax:954-923-1299
Practice Address - Street 1:120 KAIULANI AVE STE 10-11
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-6203
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:954-923-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD19541208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty