MEDICARE: ADVANCED WOUND SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	2013968	NY

General Provider Information

NPI Number	:	1093105348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WOUND SOLUTIONS

Provider Business Mailing Address
First Line	:	3724 24TH ST
Second Line	:	SUITE 242
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3553
Country	:	US
Telephone Number	:	718-606-2590
Fax Number	:	718-606-6087

Provider Business Practice Location Address
First Line	:	3724 24TH ST
Second Line	:	SUITE 242
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3553
Country	:	US
Telephone Number	:	718-606-2590
Fax Number	:	718-606-6087

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEMETRIOS SOTEROPOULOS
Credential	:
Telephone Number	:	917-921-3772

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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Directions to “ADVANCED WOUND SOLUTIONS ” Practice Location

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