Organization
WIGGIES
Active
Organization
WIGGIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE MONTEBELLO CRANIAL PROSTHETICS (CO OWNER)
(845) 430-0944
Entity
Organization
Contact information
Practice address
26 ELM RD, LK PEEKSKILL, NY 10537-1416
(845) 430-0944
Mailing address
26 ELM RD, LK PEEKSKILL, NY 10537-1416
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
22M00051696
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22M00051696
DIVISION OF LICENSING SERVICES
NY
Enumeration date
01/27/2016
Last updated
01/27/2016
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