1245409382 NPI number — VICTOR DERMATOLOGY & REJUVENATION, PC

Table of content: (NPI 1245409382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245409382 NPI number — VICTOR DERMATOLOGY & REJUVENATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTOR DERMATOLOGY & REJUVENATION, 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:
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:
1245409382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E 76TH ST
Provider Second Line Business Mailing Address:
6 FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-249-3050
Provider Business Mailing Address Fax Number:
212-249-1482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E 76TH ST
Provider Second Line Business Practice Location Address:
6 FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-249-3050
Provider Business Practice Location Address Fax Number:
212-249-1482
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VICTOR
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-249-3050

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  138656 , 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)





Copyright © 2007-2025 www.npivalidator.com