| NPI | 1699418061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH C WILFRED Trichologist/Cosmetologist 718-541-7307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| 332900000X Non-Pharmacy Dispensing Site | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-04-14 |