Healthcare Provider Details

I. General information

NPI: 1245017177
Provider Name (Legal Business Name): THE PARRUCCHE GARBIERE WIGS STUDIO, LIMITED LIABILITY CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 NORTH ALBANY AVENUE UNIT 1
ATLANTIC CITY NJ
08401-1164
US

IV. Provider business mailing address

21 N ALBANY AVE UNIT 1
ATLANTIC CITY NJ
08401-3508
US

V. Phone/Fax

Practice location:
  • Phone: 862-271-9417
  • Fax: 609-328-9447
Mailing address:
  • Phone: 732-713-9543
  • Fax: 888-289-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANTHONY PAOLERCIO
Title or Position: PRINCIPAL CEO
Credential:
Phone: 732-713-9543