Healthcare Provider Details

I. General information

NPI: 1285198549
Provider Name (Legal Business Name): VICTORIA DRUZIAKO LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 WHITE PLAINS RD
BRONX NY
10467-5708
US

IV. Provider business mailing address

64 SHARON ST APT 2
BROOKLYN NY
11211-2604
US

V. Phone/Fax

Practice location:
  • Phone: 609-774-3683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number002293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: