# INTEGRATED WOUND CARE PENNSYLVANIA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447722863
- **Authorized official:** DR. DIANE LUSA MD (PRESIDENT)
- **Authorized official phone:** (718) 705-6010

## Contact information

- **Practice address:** 4400 W GIRARD AVE, PHILADELPHIA, PA 19104-1002
- **Practice address phone:** (718) 705-6010
- **Mailing address:** 492C CEDAR LN STE 514, TEANECK, NJ 07666-1713
- **Mailing address phone:** (718) 705-6010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/24/2018
- **Last updated:** 02/23/2022