Provider Demographics
NPI:1811188105
Name:DELIA FOX D.B.A. DELIAS WIGS & COIFFURES, INC
Entity Type:Organization
Organization Name:DELIA FOX D.B.A. DELIAS WIGS & COIFFURES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:EDEN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:LHD
Authorized Official - Phone:781-826-3881
Mailing Address - Street 1:47 PANTOOSET RD.
Mailing Address - Street 2:@ COUNTRY VILLA H.S.
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339
Mailing Address - Country:US
Mailing Address - Phone:781-826-3881
Mailing Address - Fax:508-747-5935
Practice Address - Street 1:47 PANTOOSET RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339
Practice Address - Country:US
Practice Address - Phone:781-826-3881
Practice Address - Fax:508-747-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PROV701012OtherHARVARD PILGRIM
PROVDE385954OtherBC BLUE SHIELD
PROVDE385954OtherBC BLUE SHIELD