Healthcare Provider Details

I. General information

NPI: 1932075009
Provider Name (Legal Business Name): AM BEAUTY MEDICAL WIGS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 74TH AVE
PHILADELPHIA PA
19138-2220
US

IV. Provider business mailing address

1901 74TH AVE
PHILADELPHIA PA
19138-2220
US

V. Phone/Fax

Practice location:
  • Phone: 215-359-9620
  • Fax:
Mailing address:
  • Phone: 215-359-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MARKIEA LEAK
Title or Position: CRANIAL PROSTHESIS SPECIALIST
Credential:
Phone: 267-690-6529