NPIMap

Organization Active NPI

Renew Wound Care of Pennsylvania LLC

  • Internal Medicine Physician
  • Wyncote, PA
National Provider Identifier
1194442640
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RENEW WOUND CARE OF PENNSYLVANIA LLC
Practice address
8100 Washington LN
Wyncote, PA 19095-1600
Phone
(718) 408-8860
NPI assigned
Oct 25, 2022
Last updated
Jun 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Authorized official

Name
Joseph Wiesenfeld
Title
Administrator
Phone
(718) 408-8860

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X NU
Internal Medicine Physician 207R00000X NU Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU

Addresses

Primary practice location

8100 Washington LN
Wyncote, PA 19095-1600

Mailing address

1481 McDonald Ave
Brooklyn, NY 11230-4667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221206000850 PA Part B Supplier - Clinic/Group Practice 4587033022 Receives reassigned benefits from 28 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1194442640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1481 MCDONALD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112304667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 WASHINGTON LN",
            "city": "WYNCOTE",
            "state": "PA",
            "postal_code": "190951600",
            "telephone_number": "718-408-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW WOUND CARE OF PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-25",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A",
        "authorized_official_last_name": "WIESENFELD",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-408-8860"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyncote, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.