| Wound Care Medicine Pc | |
|
290 Lafayette Ave Hawthorne NJ 07506-1961 | |
| (973) 427-9200 | |
| Not Available |
| Full Name | Wound Care Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 290 Lafayette Ave, Hawthorne, New Jersey |
| Authorized Official Name and Position | Sekuleo Gathers (PROVIDER/OWNER) |
| Authorized Official Contact | 9734279200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wound Care Medicine Pc 290 Lafayette Ave Hawthorne NJ 07506-1961 Ph: (973) 427-9200 | Wound Care Medicine Pc 290 Lafayette Ave Hawthorne NJ 07506-1961 Ph: (973) 427-9200 |
| NPI Number | 1629794656 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 08/22/2024 |
| Medicare PECOS PAC ID | 9638541535 |
|---|---|
| Medicare Enrollment ID | O20230201003084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629794656 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Alex Pavon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700819208 PECOS PAC ID: 3072562107 Enrollment ID: I20050115000155 |
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