Provider Demographics
NPI:1487195848
Name:WIGTOWNE
Entity Type:Organization
Organization Name:WIGTOWNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-239-2480
Mailing Address - Street 1:117 WASHINGTON AVE.
Mailing Address - Street 2:NORTH HAVEN SHOPPING CTNR
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-239-2480
Mailing Address - Fax:
Practice Address - Street 1:117 WASHINGTON AVE.
Practice Address - Street 2:NORTH HAVEN SHOPPING CNTR
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-239-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies