Provider Demographics
NPI:1255843819
Name:WIGS BY ANGELLINE
Entity Type:Organization
Organization Name:WIGS BY ANGELLINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-559-0033
Mailing Address - Street 1:381 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3316
Mailing Address - Country:US
Mailing Address - Phone:845-559-0033
Mailing Address - Fax:
Practice Address - Street 1:381 MAIN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3316
Practice Address - Country:US
Practice Address - Phone:845-559-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherN/A