Provider Demographics
NPI:1225205974
Name:AMBIANCE WIG & PROSTHETICS
Entity Type:Organization
Organization Name:AMBIANCE WIG & PROSTHETICS
Other - Org Name:LAURA M BATTISTONI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATTISTONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-569-3108
Mailing Address - Street 1:549 COLLEGE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9774
Mailing Address - Country:US
Mailing Address - Phone:413-569-3580
Mailing Address - Fax:413-455-2923
Practice Address - Street 1:549 COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9774
Practice Address - Country:US
Practice Address - Phone:413-569-3580
Practice Address - Fax:413-455-2923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBIANCE WIGS AND PROSTHETIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
695968OtherTUFTS
MA400854OtherBCBS
695968OtherTUFTS