=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689531899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WANDERCRAFT, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 345 PARK AVE S
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-448-4787
-----------------------------------------------------
Fax | 877-827-9828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 345 PARK AVE S
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-448-4787
-----------------------------------------------------
Fax | 877-827-9828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REIMBURSEMENT AND ACCESS MANAGER
-----------------------------------------------------
Name | JOSHUA BREIGHNER
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 646-934-2189
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225000000X
-----------------------------------------------------
Taxonomy Name | Orthotic Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------