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General NPI Number Information
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NPI Number | 1801192729
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Entity Type | Organization
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Legal Business Name | IRENE'S WIGS STUDIO
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 1323 46TH ST LEVEL-C (BASEMENT)
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City | BROOKLYN
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State | NY
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Zip | 11219-2165
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Country | US
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Telephone | 718-851-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 HARING ST APT 3F
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City | BROOKLYN
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State | NY
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Zip | 11235-1834
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Country | US
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Telephone | 718-851-4770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. IRINA GILMAN
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Credential |
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Telephone | 718-851-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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