Organization
LILLYS FINE LINGERIE, INC.
Active
Other names
dba Lillys Mastectomy & Wig Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE M BRUSCELLA CMF (OWNER)
(516) 674-8109
Entity
Organization
Contact information
Practice address
5 STATION PLAZA, GLEN HEAD, NY 11545
(516) 674-8109
Mailing address
5 STATION PLAZA, GLEN HEAD, NY 11545
(516) 674-8109
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/04/2006
Last updated
03/19/2012
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