Provider Demographics
NPI:1194473207
Name:LUXTRESSES CRANIAL WIGS INC
Entity Type:Organization
Organization Name:LUXTRESSES CRANIAL WIGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-210-4158
Mailing Address - Street 1:3811 DITMAS BLVD
Mailing Address - Street 2:#2197
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105
Mailing Address - Country:US
Mailing Address - Phone:929-210-4158
Mailing Address - Fax:
Practice Address - Street 1:3328 73RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1140
Practice Address - Country:US
Practice Address - Phone:929-210-4158
Practice Address - Fax:240-213-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier