Wound Pros New York

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

WOUND PROS NEW YORK

Practice address

400 White Spruce Blvd Ste 134
Brighton, NY 14623

Phone

(323) 545-3676

Fax

(323) 433-9177

NPI assigned

Dec 13, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Ayodele Otiko, MDNPI 1346223997

Title

President

Phone

(818) 836-2475

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Ayodele Otiko, DPM

  • Podiatrist
  • Reseda, CA
  • NPI 1346223997
  NPD (past) Authorized official

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1982242525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY STE 500",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926636",
            "telephone_number": "818-836-2475",
            "fax_number": "323-433-9177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WHITE SPRUCE BLVD STE 134",
            "city": "BRIGHTON",
            "state": "NY",
            "postal_code": "14623",
            "telephone_number": "323-545-3676",
            "fax_number": "323-433-9177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOUND PROS NEW YORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-13",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "OTIKO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "AYODELE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-836-2475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Jennifer Mistark, RN
• Shaquana Latifah Nevels, LPN
• Cassandra Peete, PA-C
• Christopher Adolphus Reader, RN
• Melinda Sue Westbrook, NP

• All providers in Brighton, NY
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.