Provider Demographics
NPI:1881409894
Name:THE WIG BOUTIQUE
Entity type:Organization
Organization Name:THE WIG BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICKELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-979-7847
Mailing Address - Street 1:695 HAMILTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3274
Mailing Address - Country:US
Mailing Address - Phone:732-301-0195
Mailing Address - Fax:
Practice Address - Street 1:695 HAMILTON ST STE B
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3274
Practice Address - Country:US
Practice Address - Phone:732-301-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier