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General NPI Number Information
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NPI Number | 1225545700
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Entity Type | Organization
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Legal Business Name | PETER F WIGG PSYD PSYCHOLOGIST PC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 810 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2563
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Country | US
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Telephone | 631-365-5241
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Fax | 631-208-8555
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Provider Business Mailing Address
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Address Line | PO BOX 393
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City | EASTPORT
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State | NY
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Zip | 11941-0393
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Country | US
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Telephone | 631-365-5241
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Fax | 631-208-8555
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | PETER F WIGG
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Credential | PSY D
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Telephone | 631-365-5241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 016702
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License Number State | NY
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