Provider Demographics
NPI:1346561768
Name:EAST COAST WOUND CARE, P.C.
Entity type:Organization
Organization Name:EAST COAST WOUND CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SPERO
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:976 MCLEAN AVE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-6790
Practice Address - Street 1:976 MCLEAN AVE
Practice Address - Street 2:SUITE 387
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4105
Practice Address - Country:US
Practice Address - Phone:914-237-6797
Practice Address - Fax:914-237-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3006Medicare PIN
NJ153404Medicare PIN
FLK6749CMedicare PIN
TX00W112Medicare PIN