1225279540 NPI number — VICTORIA ANN MENTASTI PHYSICIAN ASST.

Table of content: VICTORIA ANN MENTASTI PHYSICIAN ASST. (NPI 1225279540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225279540 NPI number — VICTORIA ANN MENTASTI PHYSICIAN ASST.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENTASTI
Provider First Name:
VICTORIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASST.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1225279540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 43RD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-369-1900
Provider Business Mailing Address Fax Number:
718-965-4157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 43RD STREET
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:
11232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-369-1900
Provider Business Practice Location Address Fax Number:
718-965-4157
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  009950 , 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)





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