Provider Demographics
NPI:1447307343
Name:WIGS PLUS
Entity type:Organization
Organization Name:WIGS PLUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-737-2850
Mailing Address - Street 1:3201 MIDDLE COUNTRY RD
Mailing Address - Street 2:STE 2
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2128
Mailing Address - Country:US
Mailing Address - Phone:631-737-2850
Mailing Address - Fax:631-737-8765
Practice Address - Street 1:3201 MIDDLE COUNTRY RD
Practice Address - Street 2:STE 2
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2128
Practice Address - Country:US
Practice Address - Phone:631-737-2850
Practice Address - Fax:631-737-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier