Organization
WOUND CARE SPECIALISTS OF NY, LLC
Active
Other names
WOUND CARE SPECIALISTS, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN BRENES (MEMBER)
(203) 598-6045
Entity
Organization
Contact information
Practice address
100 PARK AVE RM 1600, NEW YORK, NY 10017-5538
(203) 598-6046
Mailing address
76 BATTERSON PARK RD STE 106, FARMINGTON, CT 06032-2571
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
CMS
NY
05
—
PENDING
—
NY
Enumeration date
03/23/2022
Last updated
03/23/2022
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