Provider Demographics
NPI:1811678014
Name:LIVS WIGS LLC
Entity type:Organization
Organization Name:LIVS WIGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SINGLE LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-706-4531
Mailing Address - Street 1:1078 SUMMIT AVE # 706
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3438
Mailing Address - Country:US
Mailing Address - Phone:347-706-4531
Mailing Address - Fax:
Practice Address - Street 1:16 TROY ST UNIT 101
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3836
Practice Address - Country:US
Practice Address - Phone:862-216-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier