Organization
THE WIG OUTLET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ERICA CHRISTIN BRODERICK (BUSINESS OWNER)
(914) 644-9447
Entity
Organization
Contact information
Practice address
194 CENTRAL PARK AVENUE, HARTSDALE, NY 10530
(914) 644-9447
Mailing address
194 SO. CENTRAL PARK AVENUE, HARTSDALE, NY 10530
(914) 644-9447
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NY
332BC3200X
Customized Equipment (DME)
—
NY
Other
Enumeration date
10/10/2013
Last updated
10/10/2013
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