Healthcare Provider Details

I. General information

NPI: 1447307343
Provider Name (Legal Business Name): WIGS PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MIDDLE COUNTRY RD STE 2
LAKE GROVE NY
11755-2128
US

IV. Provider business mailing address

3201 MIDDLE COUNTRY RD STE 2
LAKE GROVE NY
11755-2128
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-2850
  • Fax: 631-737-8765
Mailing address:
  • Phone: 631-737-2850
  • Fax: 631-737-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY BISSERT
Title or Position: MANAGER
Credential:
Phone: 631-737-2850