Healthcare Provider Details

I. General information

NPI: 1437478898
Provider Name (Legal Business Name): INTEGRATED WOUND SPECIALISTS OF ELIZABETH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE 104
ELIZABETH NJ
07202-3674
US

IV. Provider business mailing address

PO BOX 848591
BOSTON MA
02284-8591
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5480
  • Fax: 908-994-8802
Mailing address:
  • Phone: 904-446-3451
  • Fax: 904-446-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANK WILLIAMS
Title or Position: CEO
Credential:
Phone: 904-446-3519