Provider Demographics
NPI:1447766191
Name:WURGLICS, MICHELE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:WURGLICS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1314
Mailing Address - Country:US
Mailing Address - Phone:631-219-9050
Mailing Address - Fax:631-585-0425
Practice Address - Street 1:161 CENTEREACH MALL
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2750
Practice Address - Country:US
Practice Address - Phone:631-467-0402
Practice Address - Fax:631-585-0425
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009956156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician