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Organization
EAST COAST WOUND CARE P C
Active
Organization
EAST COAST WOUND CARE P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG BUNKER (DIRECTOR OF OPERATIONS)
(914) 237-6797
Entity
Organization
Contact information
Practice address
976 MCLEAN AVE, SUITE 387, YONKERS, NY 10704-4105
(914) 237-6797
(914) 237-6790
Mailing address
976 MCLEAN AVE, SUITE 387, YONKERS, NY 10704-4105
(914) 237-6797
(914) 237-6790
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050431
MEDICAID
NJ
01
—
0360569772
MEDICAID
IL
05
—
200216370A
—
OK
05
—
277265500
—
FL
Enumeration date
05/08/2006
Last updated
07/27/2010
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