Healthcare Provider Details

I. General information

NPI: 1922573740
Provider Name (Legal Business Name): ADVANCED WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PROSPECT AVE APT 8E
HACKENSACK NJ
07601-2248
US

IV. Provider business mailing address

140 PROSPECT AVE APT 8E
HACKENSACK NJ
07601-2248
US

V. Phone/Fax

Practice location:
  • Phone: 914-907-5770
  • Fax:
Mailing address:
  • Phone: 914-907-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SEBY JACOB
Title or Position: OWNER
Credential: MD
Phone: 914-907-5770