Renew Wound Care of Missouri LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

RENEW WOUND CARE OF MISSOURI LLC

Practice address

110 Highland Ave
Valley Park, MO 63088-1422

Phone

(929) 491-7700

NPI assigned

Nov 19, 2021

Last updated

Jun 27, 2023By the provider in NPPES

Organization subpart

No

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

Addresses

Locations

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1659038123",
    "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": "110 HIGHLAND AVE",
            "city": "VALLEY PARK",
            "state": "MO",
            "postal_code": "630881422",
            "telephone_number": "929-491-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW WOUND CARE OF MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-19",
        "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": []
}

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• Internal Medicine Physician in Valley Park, MO
• Providers in Valley Park, MO by specialty
• Internal Medicine Physician in Missouri

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.