Healthcare Provider Details

I. General information

NPI: 1407779119
Provider Name (Legal Business Name): WOUND CARE MEDICAL OF NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 DAVENPORT AVE APT 3E
NEW ROCHELLE NY
10805-3407
US

IV. Provider business mailing address

39 DAVENPORT AVE APT 3E
NEW ROCHELLE NY
10805-3407
US

V. Phone/Fax

Practice location:
  • Phone: 407-446-3323
  • Fax: 917-268-9689
Mailing address:
  • Phone: 407-446-3323
  • Fax: 917-268-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH SIDAOUI
Title or Position: CEO
Credential: MD
Phone: 407-446-3323