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NPI Code Detail

MEDICARE: HOWARD R WIGDOR

MEDICARE: HOWARD R WIGDOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist046308NY
2183500000XPharmacist25963NJ

General Provider Information

NPI Number : 1962486225
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOWARD R WIGDOR
Provider Business Mailing Address
First Line : 30 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8301
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8301
Country : US
Telephone Number : 631-666-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 03/11/2010

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