Provider Demographics
NPI:1902102130
Name:NORTHEAST WOUND CARE INC
Entity Type:Organization
Organization Name:NORTHEAST WOUND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:SHOLOM
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-804-1661
Mailing Address - Street 1:456 BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1725
Mailing Address - Country:US
Mailing Address - Phone:917-804-1661
Mailing Address - Fax:516-536-5887
Practice Address - Street 1:456 BARNARD AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1725
Practice Address - Country:US
Practice Address - Phone:917-804-1661
Practice Address - Fax:516-536-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-06
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies