1720011133 NPI number — VICTORY EMERGENCY PHYSICIANS, PC

Table of content: (NPI 1720011133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720011133 NPI number — VICTORY EMERGENCY PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORY EMERGENCY PHYSICIANS, PC
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:
VICTORY EMERGENCY PHYSICIANS, PC
Provider Other Organization Name Type Code:
4
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:
1720011133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 W 34TH ST
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-563-2497
Provider Business Mailing Address Fax Number:
212-563-0605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
699 92ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11228-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-563-2497
Provider Business Practice Location Address Fax Number:
212-563-0605
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLASHNER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR/ PARTNER
Authorized Official Telephone Number:
212-563-2497

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207PP0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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