NPIMap

Organization Active NPI

Advanced Wound Care Medical Practice, PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Hicksville, NY
National Provider Identifier
1295783934
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
ADVANCED WOUND CARE MEDICAL PRACTICE, PC
Practice address
31 Tec St
Hicksville, NY 11801-3618
Phone
(516) 478-9303
Fax
(516) 932-3672
NPI assigned
May 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Marie Carmel Jacques, MDNPI 1457488082
Title
President
Phone
(516) 478-9303

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0300X Primary

Addresses

Primary practice location

31 Tec St
Hicksville, NY 11801-3618

Mailing address

31 Tec St
Hicksville, NY 11801-3618
Phone (516) 478-9303

National Provider Directory

National Provider Directory

Locations

31 Tec St
Hicksville, NY 11801
Phone (516) 478-9303

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295783934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 TEC ST",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118013618",
            "telephone_number": "516-478-9303",
            "fax_number": "516-932-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 TEC ST",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118013618",
            "telephone_number": "516-478-9303",
            "fax_number": "516-932-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED WOUND CARE MEDICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACQUES",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "CARMEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-478-9303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.