Healthcare Provider Details

I. General information

NPI: 1033186408
Provider Name (Legal Business Name): VICTORIA PIROGOVSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WARREN AVE # 104
SPRING LAKE NJ
07762-2039
US

IV. Provider business mailing address

600 WARREN AVE
SPRING LAKE NJ
07762-2039
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-1444
  • Fax:
Mailing address:
  • Phone: 732-974-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA070742
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8248303
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: