Organization
NEW WIG SALON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH LOCICERO (MEMBER)
(631) 553-3987
Entity
Organization
Contact information
Practice address
378 RIDGEFIELD RD, HAUPPAUGE, NY 11788-2316
(631) 553-3987
Mailing address
378 RIDGEFIELD RD, HAUPPAUGE, NY 11788-2316
(631) 553-3987
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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