Healthcare Provider Details

I. General information

NPI: 1164544623
Provider Name (Legal Business Name): NATIONAL WOUND CARE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SUSSEX RD
WOOD RIDGE NJ
07075-1305
US

IV. Provider business mailing address

509 SUSSEX RD
WOOD RIDGE NJ
07075-1305
US

V. Phone/Fax

Practice location:
  • Phone: 201-321-8970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00290700
License Number StateNJ

VIII. Authorized Official

Name: DR. KHURRAM KHAN
Title or Position: PRESIDENT & CEO
Credential: DPM
Phone: 201-321-8970