Individual
BLAIR WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-9876
Mailing address
630 W 168TH ST # 4, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
013582
NY
363AM0700X
Medical Physician Assistant
013582-1
NY
Other
Enumeration date
05/12/2010
Last updated
08/30/2022
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