Healthcare Provider Details

I. General information

NPI: 1922889104
Provider Name (Legal Business Name): RENEW WOUND CARE OF MAINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 ELM ST
NORTH BERWICK ME
03906-6792
US

IV. Provider business mailing address

1481 MCDONALD AVE
BROOKLYN NY
11230-4667
US

V. Phone/Fax

Practice location:
  • Phone: 929-491-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH WIESENFELD
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-408-8860