Organization
PRISTINE WIGS
Active
Organization
PRISTINE WIGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA YAKUBOVA (MEDICAL WIG SPECIALIST)
(347) 281-0496
Entity
Organization
Contact information
Practice address
15306 78TH AVE, FLUSHING, NY 11367-3439
(347) 281-0496
Mailing address
15306 78TH AVE, FLUSHING, NY 11367-3439
(347) 281-0496
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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