Provider Demographics
NPI:1013417989
Name:WIGMEDINC
Entity Type:Organization
Organization Name:WIGMEDINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RIFKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-809-5852
Mailing Address - Street 1:2346 CRYSTAL MILE CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1464
Mailing Address - Country:US
Mailing Address - Phone:718-809-5852
Mailing Address - Fax:
Practice Address - Street 1:1460 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4617
Practice Address - Country:US
Practice Address - Phone:718-809-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier