NPIMap

Organization Active NPI

Renew Wound Care of Connecticut PLLC

  • Internal Medicine Physician
  • Bristol, CT
National Provider Identifier
1992492854
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 CONNECTICUT PLLC
Practice address
23 Fair St
Bristol, CT 06010-5531
Phone
(718) 408-8860
NPI assigned
Apr 20, 2023
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
Internal Medicine Physician 207R00000X Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X

Addresses

Primary practice location

23 Fair St
Bristol, CT 06010-5531

Mailing address

1481 McDonald Ave
Brooklyn, NY 11230-4667

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230508002087 CT Part B Supplier - Clinic/Group Practice 2668837014 Receives reassigned benefits from 15 practitioners
Practice locations: Bristol, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1681948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1992492854",
    "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": "23 FAIR ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105531",
            "telephone_number": "718-408-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW WOUND CARE OF CONNECTICUT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-20",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

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.