Provider Demographics
NPI:1720424344
Name:WOUND HEALING OF ESSEX, L.L.C.
Entity type:Organization
Organization Name:WOUND HEALING OF ESSEX, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:GEORGES
Authorized Official - Last Name:LOSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-274-1240
Mailing Address - Street 1:151 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1132
Mailing Address - Country:US
Mailing Address - Phone:973-274-1240
Mailing Address - Fax:
Practice Address - Street 1:151 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1132
Practice Address - Country:US
Practice Address - Phone:973-274-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3710301Medicaid
NJC56752Medicare UPIN