| Organization Name: | ADVANCED WOUND CARE MEDICAL PC |
| NPI Number: | 1699726315 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SERGEI KOCHLATYI (MEDICAL DIRECTOR) |
| Mailing Address: | 454 Avenue U Brooklyn |
| State: | NY US |
| Postal Code: | 112234011 |
| Phone Number: | 7183823400 |
| Fax Number: | 7183823420 |
| NPI Enumeration Date: | 05/15/2006 |
| NPI Last Update Date: | 10/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 227059 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |