=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023459781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANAGED WOUND CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2013
-----------------------------------------------------
Last Update Date | 07/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 CAREY AVE STE 212
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07405-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-330-1555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 CAREY AVE STE 212
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07405-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-330-1555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LISA MARIE ALLEGRI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-330-1555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------