1235731977 NPI number — JEFFREY L. GALITZ MD LLC DBA WOUNDTECH MD OF NEW JERSEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235731977 NPI number — JEFFREY L. GALITZ MD LLC DBA WOUNDTECH MD OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY L. GALITZ MD LLC DBA WOUNDTECH MD OF NEW JERSEY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235731977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S PARK RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021-8541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-923-7440
Provider Business Mailing Address Fax Number:
954-923-1299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S PARK RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-8541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-923-7440
Provider Business Practice Location Address Fax Number:
954-923-1299
Provider Enumeration Date:
11/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GALITZ
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
954-923-7440

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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