Provider Demographics
NPI:1225545700
Name:PETER F WIGG PSYD PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:PETER F WIGG PSYD PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:WIGG
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:631-365-5241
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-0393
Mailing Address - Country:US
Mailing Address - Phone:631-365-5241
Mailing Address - Fax:631-208-8555
Practice Address - Street 1:810 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2563
Practice Address - Country:US
Practice Address - Phone:631-365-5241
Practice Address - Fax:631-208-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty