1104202993 NPI number — VICTORIA VAMOS, NURSE PRACTITIONER IN FAMILY HEALTH, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104202993 NPI number — VICTORIA VAMOS, NURSE PRACTITIONER IN FAMILY HEALTH, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIA VAMOS, NURSE PRACTITIONER IN FAMILY HEALTH, P.C.
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:
LONG ISLAND MEDICAL AND SPA
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:
1104202993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 COATES AVE
Provider Second Line Business Mailing Address:
SUITE 31
Provider Business Mailing Address City Name:
HOLBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11741-6039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-580-0000
Provider Business Mailing Address Fax Number:
631-580-0001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 COATES AVE
Provider Second Line Business Practice Location Address:
SUITE 31
Provider Business Practice Location Address City Name:
HOLBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11741-6039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-580-0000
Provider Business Practice Location Address Fax Number:
631-580-0001
Provider Enumeration Date:
08/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VAMOS
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
631-580-0000

Provider Taxonomy Codes

  • Taxonomy code: 364SF0001X , with the licence number:  F333441 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02633829 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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