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General NPI Number Information
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NPI Number | 1922889104
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Entity Type | Organization
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Legal Business Name | RENEW WOUND CARE OF MAINE PLLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 47 ELM ST
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City | NORTH BERWICK
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State | ME
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Zip | 03906-6792
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Country | US
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Telephone | 929-491-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 MCDONALD AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-4667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPH WIESENFELD
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Credential |
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Telephone | 718-408-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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