Provider Demographics
NPI:1932075009
Name:AM BEAUTY MEDICAL WIGS CORP.
Entity type:Organization
Organization Name:AM BEAUTY MEDICAL WIGS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARKIEA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-690-6529
Mailing Address - Street 1:1901 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2220
Mailing Address - Country:US
Mailing Address - Phone:215-359-9620
Mailing Address - Fax:
Practice Address - Street 1:1901 74TH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-2220
Practice Address - Country:US
Practice Address - Phone:215-359-9620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty