MEDICARE: BRACHA BARD-WIGDOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1982449880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRACHA BARD-WIGDOR

Provider Business Mailing Address
First Line	:	587 RIVERSIDE DR
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-3117
Country	:	US
Telephone Number	:	718-360-6273
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 EASTBOURNE DR
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-6403
Country	:	US
Telephone Number	:	718-360-6273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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Directions to “ BRACHA BARD-WIGDOR ” Practice Location

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