Innovation Wound Care Associates, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

115251 Issued in NY

Legal business name

INNOVATION WOUND CARE ASSOCIATES, LLC

Practice address

20 E Sunrise Hwy
Suite 301
Valley Stream, NY 11581-1260

Phone

(516) 569-2828

Fax

(516) 295-4145

NPI assigned

Oct 29, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gilbert G. Makabali, MD

Title

President

Phone

(516) 569-2828

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383004800000",
    "number": "1003244138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E SUNRISE HWY",
            "address_2": "SUITE 301",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811260",
            "telephone_number": "516-569-2828",
            "fax_number": "516-295-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E SUNRISE HWY",
            "address_2": "SUITE 301",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811260",
            "telephone_number": "516-569-2828",
            "fax_number": "516-295-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATION WOUND CARE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2013-10-29",
        "status": "A",
        "authorized_official_last_name": "MAKABALI",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-569-2828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "115251",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "006327",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.