Organization
ADVANCED WOUND CARE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGEI KOCHLATYI M.D. (MEDICAL DIRECTOR)
(718) 382-3400
Entity
Organization
Contact information
Practice address
454 AVENUE U, BROOKLYN, NY 11223-4011
(718) 382-3400
(718) 382-3420
Mailing address
454 AVENUE U, BROOKLYN, NY 11223-4011
(718) 382-3400
(718) 382-3420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
218265
NY
208600000X
Surgery Physician
087860
NY
208600000X
Surgery Physician
150869
NY
208D00000X
General Practice Physician
156598
NY
208D00000X
General Practice Physician
227059
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07132
GHI MEDICARE
NY
Enumeration date
05/15/2006
Last updated
10/17/2007
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