1992070494 NPI number — WIGGLY KIDLETS

Table of content: (NPI 1992070494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992070494 NPI number — WIGGLY KIDLETS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIGGLY KIDLETS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW YORK UNLIMITED HEATHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992070494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 TRENTON RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-371-0817
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3145 CENTER POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-8433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-371-0817
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OBARE
Authorized Official First Name:
DAFFNEY
Authorized Official Middle Name:
VEALS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-371-0817

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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