Healthcare Provider Details

I. General information

NPI: 1063094860
Provider Name (Legal Business Name): SHAINDYS WIGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 AMERICA AVE
LAKEWOOD NJ
08701-4625
US

IV. Provider business mailing address

12 AMERICA AVE
LAKEWOOD NJ
08701-4625
US

V. Phone/Fax

Practice location:
  • Phone: 731-370-1337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAINDY LEINER
Title or Position: OWNER
Credential:
Phone: 732-370-1337