Healthcare Provider Details

I. General information

NPI: 1063654085
Provider Name (Legal Business Name): JOHN WOODS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 92ND ST APT 24E
NEW YORK NY
10128-6811
US

IV. Provider business mailing address

408 E 92ND ST APT 24E
NEW YORK NY
10128-6811
US

V. Phone/Fax

Practice location:
  • Phone: 917-743-8539
  • Fax:
Mailing address:
  • Phone: 917-743-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number67287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: