Healthcare Provider Details

I. General information

NPI: 1649746645
Provider Name (Legal Business Name): DR. STEVEN E. WIGDOR, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17941 BISCAYNE BLVD
AVENTURA FL
33160-2502
US

IV. Provider business mailing address

17941 BISCAYNE BLVD
AVENTURA FL
33160-2502
US

V. Phone/Fax

Practice location:
  • Phone: 305-931-0225
  • Fax: 305-931-0238
Mailing address:
  • Phone: 305-931-0225
  • Fax: 305-931-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WIGDOR
Title or Position: AUTHORIZED OFFICIAL
Credential: OD
Phone: 305-931-0225