Healthcare Provider Details

I. General information

NPI: 1346561768
Provider Name (Legal Business Name): EAST COAST WOUND CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 01/31/2011
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: DR. SPERO J THEODOROU
Title or Position: SURGICAL DIRECTOR
Credential: MD
Phone: 914-237-6797