Provider Demographics
NPI:1366331811
Name:EVOLUTION WOUND MANAGEMENT OF NJ PC
Entity type:Organization
Organization Name:EVOLUTION WOUND MANAGEMENT OF NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:EMDUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-684-9159
Mailing Address - Street 1:410 MONMOUTH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 MONMOUTH AVE APT 208
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3747
Practice Address - Country:US
Practice Address - Phone:720-684-9159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty