| Integrated Wound Specialists Of Elizabeth, Llc | |
|
240 Williamson St Suite 104 Elizabeth NJ 07202-3674 | |
| (908) 994-5480 | |
| (908) 994-8802 |
| Full Name | Integrated Wound Specialists Of Elizabeth, Llc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 240 Williamson St, Elizabeth, New Jersey |
| Authorized Official Name and Position | Frank Williams (CEO) |
| Authorized Official Contact | 9044463519 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Wound Specialists Of Elizabeth, Llc Po Box 848591 Boston MA 02284-8591 Ph: (904) 446-3451 | Integrated Wound Specialists Of Elizabeth, Llc 240 Williamson St Suite 104 Elizabeth NJ 07202-3674 Ph: (908) 994-5480 |
| NPI Number | 1437478898 |
|---|---|
| Provider Enumeration Date | 05/25/2010 |
| Last Update Date | 06/01/2023 |
| Medicare PECOS PAC ID | 6002097953 |
|---|---|
| Medicare Enrollment ID | O20110224000671 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437478898 | NPI | - | NPPES |
| 200454 | Other | NJ | GROUP MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | (* (Not Available)) | Primary |
| Provider Name | Lori T Richwine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518015783 PECOS PAC ID: 3173599503 Enrollment ID: I20040914001263 |
| Provider Name | Kenneth H Leese |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1316964356 PECOS PAC ID: 7214981406 Enrollment ID: I20050310000411 |
| Provider Name | Brian Charles Smeal |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1720194442 PECOS PAC ID: 7416033451 Enrollment ID: I20080404000431 |
| Provider Name | Lisa M Derr |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1124218540 PECOS PAC ID: 9335311828 Enrollment ID: I20111005000289 |
| Provider Name | Todd C Campbell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1710986682 PECOS PAC ID: 3678546199 Enrollment ID: I20130215000352 |
| Provider Name | Mikhail A Botvinov |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1760685622 PECOS PAC ID: 8022259092 Enrollment ID: I20130802000585 |
| Provider Name | James Javier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770858284 PECOS PAC ID: 1557526662 Enrollment ID: I20141121000860 |
| Provider Name | Toniann Stone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972899714 PECOS PAC ID: 1254559644 Enrollment ID: I20150423000869 |
| Provider Name | Steven Katz |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1508940834 PECOS PAC ID: 1658557079 Enrollment ID: I20160831000372 |
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