Healthcare Provider Details

I. General information

NPI: 1275582181
Provider Name (Legal Business Name): EAST COAST WOUND CARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 MCLEAN AVE SUITE 387
YONKERS NY
10704-4105
US

IV. Provider business mailing address

976 MCLEAN AVE SUITE 387
YONKERS NY
10704-4105
US

V. Phone/Fax

Practice location:
  • Phone: 914-237-6797
  • Fax: 914-237-6790
Mailing address:
  • Phone: 914-237-6797
  • Fax: 914-237-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG BUNKER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 914-237-6797